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Camp Office Email

This is the email address for the camp's office

Todays Unix Epoch

PARENT INFORMATION

Mother's First Name*

Father's First Name*

Last Name*

Home Phone

Mother's Cell*

Mother's Email*

Father's Cell

Father's Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shul Affiliation*

EMERGENCY CONTACT

Emergency Contact Name*

Relationship*

Emergency Phone*

Camp Fees

Sibling discount- All families will receive $50 off per child if they sign up for more than one full summer camper.

Session	Pre1A - 1st Grade (Regular Program)	2nd Grade - 3rd Grade (Regular Program)	4th and 5th Grade (CBY Stars)
Full Summer:	$1,895	$1,995	$2,145
Half Summer	$1,050	$1,100	$1,150

Additional Option

	Full Summer	Half Summer
Transportation:	$350	$175

Campers

First Name	Total For Camper	Actions

There are no Campers.

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Siblings Discount Counter:

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Siblings Discount:

Deposit:

Total:

TERMS & CONDITIONS*

I wish to enroll my daughter(s) in Camp Bnos Yam and I agree to abide by all camp rules, regulations and tznius standards as well as the below conditions.

Please Note: Applying does not guarantee acceptance to camp. Acceptances will be confirmed through an acceptance email.

This application must be accompanied by a $350 non-refundable registration fee per camper.
A credit card must be used to process your registration. No credit card fee will be charged for the registration fee.
In the event you receive a scholarship which covers part of your registration fee, you will be reimbursed for that amount.
If no payment plan has been worked out by June 1st, your credit card may be charged automatically on the first day of camp.
The camp will not be held responsible for any personal belongings that are lost, stolen or left behind in camp over the summer.
All belongings left in camp will be considered hefker one week after camp ends.
The Board of Health requires that a current medical form be on file for every camper prior to the start of camp. All medical forms must be submitted by June 1st.

CONDITIONS OF ENROLLMENT / TRIP AUTHORIZATION / HOLD HARMLESS AGREEMENT:

I have read the Conditions of Enrollment including the fees and payments. I agree to abide by these policies. I hereby authorize Camp Bnos Yam to take my child off camp grounds to go on trips organized as part of the camping program. This may include swimming and/or boating sites. In addition, my child may participate in any on or off ground activity organized by camp and I assume the inherent risk of camp activities and programs. I will hold Camp Bnos Yam harmless in the event of injury or property damage or loss as a result of such activities. I also agree to abide by all rules and regulations as set forth in the camp application, in the camper handbook and by camp administration.

I authorize any of the camp directors and adult staff members to make medical decisions on behalf of my child in the case of emergency or if I cannot be reached.

Untitled*

I understand that my daughter must cover her elbows, knees, and wear knee socks going into second grade and up.

Parent's Full Name*

Date

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Total Number

PLEASE NOTE: A credit card is required to pay for the non-refundable registration fee. You will not be charged any additional fee.

FULL PAYMENT OF YOUR BALANCE IS REQUIRED BY JUNE 1st.

There is a 3% credit card processing fee for the balance, not including the deposit.

Credit Card Payment Options:*

Pay registration + follow up with a different form of payment (Check or QuickPay)

Pay in Full

Split payments - Pay registration today, pay remaining balance in 2 installments (May 15th, June 15th) OPTION CLOSED!

Split payments - Pay registration today, pay remaining balance in 2 installments (April 15th, May 15th) OPTION CLOSED!

Split payments - Pay registration today, pay remaining balance in 3 installments (April 15th, May 15th, June 15th) OPTION CLOSED!

Deposit:

Transportation:

Siblings Discount:

Today's Payment:

Price: $0.00

Recurring Amount:

Price: $0.00

Balance:

Price: $0.00

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Payment Times

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Payment Start

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

General Comments