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Member r
Non-Member r
Parent/Guardian 2____________________________________________
Work Phone ______________________ Cell______________________
Email_____________________________________________________
Work Phone ______________________ Cell______________________
Email ____________________________________________________
Date____________________________________________________
Date___________________________________________________
Weinstein JCC • 5403 Monument Avenue • Richmond, VA • 23226 • Fax (804) 285-3139
Mail your Registration Forms to:
X______________________________________________________
Signature of Person Responsible for Payment (if different)
X______________________________________________________
Signature of Parent or Legal Guardian
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 16, I will be responsible for payment in full for all enrolled sessions.
I understand that 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 that I will be responsible for any and all attorney and court costs incurred by the Weinstein JCC.
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.
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 16, withdrawals from camp will not be refunded.
PLEASE READ CAREFULLY BEFORE SIGNING. BALANCE MUST BE PAID IN FULL NO LATER THAN JUNE 6, 2014, 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 =