E-mail Address: *
Camper Name *
Campers Present Age *
Campers Grade in the Fall of 2010 *
Campers Email Address *
Sex * Male
Female
Campers Birth Date *
Home Street Address *
City *
State *
Zip Code *
Home Phone Number *
Mothers Name *
Mothers Cell Phone *
Mothers Fax Number
Mothers Business Name
Mothers Email Address *
Fathers Name *
Fathers Cell Phone *
Fathers Fax Number
Fathers Business Name
Fathers Email Address *
Session *
How did you hear of Camp Shalom
How many years have you been to Camp Shalom?
I HAVE READ ALL OF THE POINTS BELOW * Yes

I hereby give permission for my child to attend Camp Shalom and I am enclosing a $500.00 ($750 after January 15, 2008) deposit to be credited towards the tuition fee, which I understand is to be paid in full on or before April 20th.  I give my full permission for my son/daughter to participate in all activities.  I expect my child to regard carefully all health and safety measures and standards of conduct set by Camp Shalom.  Permission is hereby granted to Camp Shalom to use individual or group photographs of my child for public relations purposes. There will be no refund if your child is asked to leave the campgrounds for any reason or if your camper arrives late or leaves early. There will be no prorated fees.

A deposit of $500.00 must accompany each enrollment, which includes a $150.00 non-refundable registration fee and will be deducted from the deposit in case of cancellation.  Deposits will not be refunded after Jan. 15th. A non- refundable $750.00 must be paid no later than January 15th, 2008 for proper bunk placement. Once a child has been registered after January 15, 2008 there will be no refund.

 The total camp fee must be paid no later than April 20th.  All fees are payable in advance unless arranged with the director. 

A medical form will be forwarded to you upon receipt of deposit and application.  This form must be completed in full by an authorized physician, notarized by the parent, and returned to the camp business office along with proof of health and accident insurance.

 We acknowledge the camp does not maintain any health or medical insurance, which would cover the child while attending camp.  The parent or legal guardian shall be responsible for the cost of all out of camp medical treatment, prescription drugs and the like provided to their child during the camping season.  Prescription medications that cannot be financially covered by the child’s spending account or parent’s credit card will be billed to the parents for prompt reimbursement. 

.Campers will be dismissed without enrollment refund for smoking, the use of any kind of stimulant, willful disobedience of rules and directives or leaving camp grounds without staff supervision. 

Camp Shalom reserves the right to refuse admission to any boy or girl whom the camp staff deem to be incompatible with the other campers. Campers must furnish a small photograph. First year campers must have references or be interviewed by a director.  Habitual bed-wetter’s cannot be accepted.

 Campers will be provided with an afternoon snack of snow cones, fruit or cookies each day.

×     Birthday cakes are provided by the camp free of charge.

Placement of campers in cabin assignments is done by chronological age and school year at the discretion of the camp director.  Requests will be honored when possible.

It is mutually understood that the camp accepts NO RESPONSIBILITY for LOSS or DAMAGE to any campers clothing or property incurred during the session or while in transit.

Parent agrees to visit camp only on the designated visiting day.

I give permission for my child to leave campgrounds for field trips and/or medical treatment.

ANY DAMAGES TO CAMP PROPERTY (WALLS, BEDS, ETC…) WILL BE CHARGED TO THE PARENTS OF THE CAMPER.

 THERE WILL BE NO CHEWING GUM ON OUR CAMPGROUNDS AT ANY TIME.

* Required

 

 
 

For Questions, Please Call (800)279-0401 or (305)279-0401 Or E-Mail Us
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