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Camp Office Email

This is the email address for the camp's office

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Today's Date*

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Todays Unix Epoch

PARENT INFORMATION

Last Name*

Mother's Name*

Mother's Cell*

Father's Name*

Father's Cell*

Street Address*

Street Address City ZIP Code

Home Phone

Email*

CAMP PRICING

Lunch included in the fee	Whole Summer	Half Summer
Kindergarten - 2nd Grade	$1,795	$995

Campers

Camper First Name	I would like to register for	Total For Camper	Actions

There are no Campers.

Deposit:

Total:

EMERGENCY CONTACTS

Name*

Relationship*

Emergency Phone*

Name*

Relationship*

Emergency Phone*

FAMILY PEDIATRICIAN

Name*

Pediatrician Phone*

CONDITIONS OF ENROLLMENT*

CONDITIONS OF ENROLLMENT

The following items require parental signature to ensure the health and safety of our campers:

I hereby give my child permission to participate in all camp activities on or off grounds.
In the event that my child requires emergency medical care and I cannot be reached, I give permission to the camp director or someone designated by the camp director to provide the medical attention needed.
I am aware that although every effort will be made to ensure the safety of each child, I commit not to hold Batsheva tashman (and Camp Hello Kiddy) responsible for any mishap, chas v'shalom.
I allow Camp Hello Kiddy to post pictures of my child online. If you do not allow, you must email us at camphellokiddy@gmail.com

(CHECK HERE IN ORDER TO CONTINUE): I agree to the conditions listed above.

Parent's Full Name*

Date

PAYMENT INFORMATION

Deposit - non refundable:

Total:

PAYMENT OPTIONS

Payment Method:*

Credit Card. There is a 3% credit card processing fee.

E-Check

Payment Options:*

Pay in Full

Split payments - Pay deposit today, pay remaining balance in 2 installments (May 1st and June 1st)

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Total Number

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Today's Payment

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Recurring Amount

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Balance

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

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Recurring Amount

Card Details*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Check Details*

Account Number Account Type Routing Number Account Holder Name

General Comments

PARENT INFORMATION

CAMP PRICING

Lunch included in the fee

EMERGENCY CONTACTS

FAMILY PEDIATRICIAN

CONDITIONS OF ENROLLMENT

PAYMENT INFORMATION

PAYMENT OPTIONS