Summer Camp Brochure 2 Summer Camp 2017 Volume 2 | Page 19

Please turn in this form to the ECE office or the Tucson J Welcome Desk ) For Camp J options ( Grades K +) see Registration page .

One form per camper please Camper Name _________________________________________ Address _____________________________________________ Parent # 1 Name _______________________________________ Phone ( H )____________________ ( W )____________________ Cell Phone ___________________________________________ Main e-mail __________________________________________

��Camp K ’ TonTon 2 years old

��Camp Yeladim 3 years old

Date of Birth _____/_____/_____ Gender _________ City / State / Zip _________________________________________ Parent # 2 Name _______________________________________ Phone ( H )____________________ ( W )____________________ Cell Phone ___________________________________________ Other e-mail _________________________________________

��Camp Shaverim 4 years old

��Camp Megalin 5 years old

Weeks S1A * & S1B Weeks S2A & S2B Weeks S3A & S3B Weeks S4A & S4B Weeks S5A & S5B

Regular Day 9 am — 4 pm

o o o o o

M-F Member Early Bird

o $ 459

M , W , F Member Early Bird

o $ 306

T / Th Member Early Bird

o $ 230

M-F Member Aft . 3 / 31

o $ 483

M , W , F Member Aft . 3 / 31

o $ 322

T / Th Member Aft . 3 / 31

o $ 242

M-F Non- Member

o $ 553

M , W , F Non- Member

o $ 392

T / Th Non- Member

o $ 312

☐ Pre-payment In Full

( enclose check made payable to TJCC or provide CC info .)

☐ Summer Payments Questions , please contact Andrea Wright at 520-299-3000 , x103 . For Inclusion and DDD registration , please contact Emily Malin at ( 520 ) 299-3000 , x168 .

Select one : ☐ Electronic Funds Transfer ( attach voided check ) ☐ Credit Card On File

☐ Check here if already on file with The J Please indicate last 4 digits __________ exp . date ______

☐ Visa / MC / Discover Card #_________________________ exp . date ______ 3-Digit Code ( from back of CC )____________

☐ Early Bird ( All Camps ) by 3 / 31 / 17

$ ___________

Registration Information Non-refundable deposits are required with registration forms . There is a one-time $ 30 enrollment fee for each child , plus $ 20 for each child for each session of camp ( will apply to camp fee ). Please mail or bring registration form to the JCC , 3800 E . River Road , Tucson , AZ 85718 . Scholarship requests are due March 31 , 2017 . For cancellation and other policies , see camp inserts . Payment option must be submitted with registration . The Camp Registrar will send an e-mail confirmation , state health forms , parent handbook , and camper intake forms . Additional registration forms are available at tucsonjcc . org or at the JCC . All schedules and programs are subject to change . Your signature below , acknowledges that you have reviewed the Camp “ J ” Registration Page and understand camp policies and the refund / cancellation policy _____ ( initial ). I , the undersigned , understand that participation in any JCC activity and use of recreational and workout facilities involve a risk of accidental injury despite all safety precautions . Therefore , as a parent and / or guardian , I will assume all risks ( injury or illness ) for my children and family members that may occur during participation in any activities or use of facilities at the JCC or on JCC supervised field trips . In case of sudden injury or illness , I hereby give authority to any hospital or doctor to render immediate aid as may be required at the time for my child ’ s health and safety . I authorize staff to apply sunscreen to avoid sunburn . I give permission for my child to swim in the JCC pool . I also give permission for my child to attend JCC supervised field trips , and for photographs to be taken and used privately and / or in JCC publications . I understand medical expenses are my responsibility . In the event that my child needs medical treatment due to an accident , injury or natural causes while registered for JCC programs , I authorize the JCC personnel to take whatever action is necessary to care for my child . I hereby give permission for JCC personnel to use their judgment in arranging for my child ’ s emergency medical treatment in addition to contacting me to the best of their ability . I certify that my child is fully covered by medical insurance and that I am fully responsible for all costs incurred due to medical or dental treatment as deemed necessary by JCC personnel . By signing this form , I acknowledge that I am aware of the potential risks of participating in activities and / or programs at the JCC , and agree to in no way hold the management , agent or employees of the JCC liable for any injury that my child / ren may sustain . I have read and understand the above statement . Camp fees due Friday prior to session .

OR

☐ Subtotal ( All Camps ) after 3 / 31 / 17

� JCC Member , � Non-Member

$ ___________

Yes , I would like to help Send a Kid to Camp .

My tax deductible donation is : ☐ $ 36 ☐ $ 72 ☐ Other $___________ Enrollment Fee $ 30.00

Total $___________

Will you be sending multiple children to camp ? Yes ___ No ____

** For Members : All siblings ( Camp J and Summer Only ECE ) receive a 5 % discount for camp .

Sign Here ________________________________________________________________________ Date ___________________________________