Camp Magazines 2020 Camps Magazine | 页面 28

Registration Information and
Rules for All Programs
ALL CAMPS REGISTRATION FORM
Please print clearly and complete a separate registration form for each family.
Camper Information
r 1. Last Name________________________ First Name________________________ Birthdate__________ Gender____ Grade (Fall ‘20) _______
Please read carefully before you complete
your camper's registration forms.
PRIORITY REGISTRATION
Registrations are processed in the order they are received. Enrollment is on a first-come, first-
served basis. Weinstein JCC family memberships must remain active throughout the entire
camp session in order to receive member rates. The registration form along with all paperwork
which includes: medical form and contact and emergency form, MUST be completed in order
for the registration to be processed. These forms can be found online at weinsteinjcc.org
and copies are also available at the Central Services Desk. If you have questions, call Joey Wood
at 545-8605. For information on Weinstein JCC membership, please contact Membership Direc-
tor Randi Amar at [e-mail] or 804-545-8635.
r 3. Last Name________________________ First Name________________________ Birthdate__________ Gender____ Grade (Fall ‘20) _______
Please check box beside the name of any child above who has special needs and/or is receiving support services (OT, PT, Speech, Hearing, Educational,
Behavioral, Counseling, Medical, etc.). If checked, you will be contacted regarding your child’s specific needs to determine eligibility and to develop
support strategies to ensure his/her success at camp. Our goal is to be proactive and supportive.
Family Information
r Member
r Non-Member
Parent/Guardian 1___________________________________________
Parent/Guardian 2____________________________________________
Address___________________________________________________ Address____________________________________________________
City/State/Zip______________________________________________ City/State/Zip_______________________________________________
Home Phone ______________________________________________
Home Phone _______________________________________________
Work Phone ______________________ Cell_____________________
Work Phone ______________________ Cell______________________
Due to licensing and camper/counselor ratios, each session has a fixed maximum number of
campers that can be accommodated. Parents will be notified if they are put on a wait list. For
the safety of our campers, enrollment cannot be expanded beyond capacity. Please register
early to ensure your placement. There is a separate wait list for each camp. Slots are filled as
space becomes available per camp. All programs are contingent upon minimum enrollment. Email ____________________________________________________
Email _____________________________________________________
FINANCIAL ASSISTANCE Name______________________________________ Relationship to Child________________ Phone________________Cell/Bus________________
LIMITED ENROLLMENT
Email addresses will be used to send camp information and photos of camp activities. Addresses will not be released outside of the Weinstein JCC.
Emergency Contact (other than parents)
parents)
Name______________________________________ Relationship to Child________________ Phone________________Cell/Bus________________
If you are in need of financial assistance, please contact Melissa Bunce at 545-8658 or email
[e-mail] to request scholarship information. Deadline for scholarship
applications is April 17, 2020. Child will not be released to anyone other than the above without written consent of parent or guardian.
INCLUSION AT SUMMER CAMP PLEASE READ CAREFULLY BEFORE SIGNING. BALANCE MUST BE PAID IN FULL NO LATER THAN JUNE 1, 2020, UNLESS A PAYMENT PLAN HAS BEEN
CONFIRMED WITH THE WEINSTEIN JCC EXECUTIVE STAFF. FEES MAY BE CHARGED ON MASTERCARD, VISA, AMERICAN EXPRESS OR BY ELECTRONIC FUNDS
TRANSFER (EFT). THERE WILL BE A $35 FEE FOR EACH CHANGE OF REGISTRATION AFTER MAY 1.
Confirmation of applications will be made only to camp registrants whose accounts reflect no balance due for other activity fees.
Camp is a place to learn, grow, and have fun! The inclusion of campers with different abilities
is important to us. If your child receives support services during the school year and/or may
need additional support to successfully participate in summer camp at the Weinstein JCC,
please contact Melissa Bunce, Director of Inclusion and Support Services at 545-8658 or
[e-mail] to determine enrollment eligibililty.
CAMP FORMS
All of our Camps require supplemental forms such as health forms and permissions forms,
to be completed and submitted prior to the first session that a camper will attend camp. No
camper will be able to attend camp unless these forms are on file. All supplemental forms
will be sent electronically to parents, so please be on the look-out for these forms.
PHOTOS AND VIDEOGRAPHY
The Weinstein JCC reserves the right to photograph and videotape camp and sports activities
for use in publicity and promotional materials. Please notify us in writing if you do not wish for
your child's photo to be used.
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r 2. Last Name________________________ First Name________________________ Birthdate__________ Gender____ Grade (Fall ‘20) _______
Physician________________________________________________ Phone_______________________________________________________
Payment Policy
For Members Only: Weinstein JCC membership must be maintained current throughout the camp season in order to receive member rates.
Refund Policy: Once the camping season begins on June 15, withdrawals from camp will not be refunded.
I understand the Weinstein JCC’s policy on camp registration, and I agree to be responsible for payment of all fees due to the Weinstein JCC.
I understand failure to make payments as required will result in termination of service and collection action will be taken. In the event that
collection action is taken, I understand I will be responsible for any and all attorney and court costs incurred by the Weinstein JCC.
I hereby grant permission for my child to be included in pictures connected with the summer camp program that may be used in marketing materials
or on the official Weinstein JCC Summer Camps Photo Gallery. To withdraw my child from any Weinstein JCC Camp program, I understand that I must
submit my request in writing to the appropriate Camp Director. I understand that should I withdraw my child from any Weinstein JCC Camp program
after June 15, I will be responsible for payment in full for all enrolled sessions.
X______________________________________________________
Signature of Parent or Legal Guardian X______________________________________________________
Signature of Person Responsible for Payment (if different)
Date___________________________________________________ Date____________________________________________________
Scan, email, fax or mail your registration form to:
Joey Wood at [e-mail] • Fax [phone] • Phone: [phone]
Or drop-off at Central Services/Control Desks at 5403 Monument Avenue, Richmond, VA 23226
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