Shemesh Day Camp Application

Parent information
Camper Information
Emergency & Medical Information
Terms & Conditions
Payment Information

Parent information

Family Name

Mother's Name

Mother's Cell

Father's Name

Father's Cell

Do You Have A Child Who Attended Shemesh Day Camp Last Year?

Home Phone

Street Address

City

State

Zip

Camp Dates:
First Session:	Monday, June 26 – Friday, July 21
Second Session:	Monday July 24 – Thursday, August 17
Full Summer:	Monday, June 26 – Thursday, August 17

Camper information

First Camper

Full First Name

Nickname

Grade Entering for 23-24 school year

I am aware that Nursery campers must be toilet-trained at time of registration. No refund will be given for campers that are not trained when camp begins.

Date of Birth

Current School

Teacher

School For Next Year

Session Attending?

Would you like to register for transportation?

Nearest Cross street/Intersection

Where are you located?

Please inquire from the camp office before completing your application, if you are unsure whether we provide transportation to your area in Jackson/Toms River.

Allergies

Bunk Placement With: (Please include up to 3 names of friends in order of preference. We can only guarantee placement with one friend)

Is there any information that would be beneficial for us to know, to better care for your child over the course of the summer?

*Please note that if your child is currently attending a special needs program, or receives assistance to be in a regular education setting, you must contact me before applying so we can best suit his/her needs. We will not offer a refund for any such child who registers without prior discussion.

**You can call our main office at 732-370-1946 as the summer gets closer if you would like to make changes to your child's bunk placement requests.

Terms and conditions

As of May 1st, the entire camp fee is non-refundable. Cancellations made before May 1st will be refunded, less the deposit of $125 per session.

We are offering the option of signing up for either whole or half summer. If you choose to take your child out of camp for a week, we cannot offer you a refund.

Although we are hoping that all details of our program remain unchanged from what is stated in the camp information packet, we have seen from previous years that circumstances may change beyond our control. Therefore, we reserve the right to change details such as time, dates, prices and activities should the need arise.

I release the directors of Shemesh Day Camp, the camp staff members and the owners and managers of the camp and pool facility from any claims of liability that may arise. I give permission to Shemesh Day Camp to make all emergency decisions regarding my child.

I have read through the camp information packet and agree to the Terms and Conditions stated above.

Name:

Signature

Date

Payment Information

Total: $

Payment

Please Select Payment Method:

Credit Card (A 3.5% Fee Applies)

Check (There is no surcharge for ACH Debit Payments)

Payment Options:

Charge my credit card for the full payment nowCharge my bank account for the full payment now

Charge my credit card for $125 per camper, per half, (non-refundable deposit) now and charge the remaining balance on May 1Charge my bank account for $125 per camper, per half, (non-refundable deposit) now and charge the remaining balance on May 1st

We accept all credit and debit card payments.

Card Details

Amount

Name On Card

Zip Code

Card Number

Expiry Date

CVV

Early Bird price: $ $

General Comments Box

Text

First Camper

Family Physician:

Please Select Payment Method:

Payment Options:

Card Details

Check Details

Welcome to Shemesh Day Camp!