Family Information
Family Name :
Home Phone:
Home Address:
Email:
Email 2:
Father's Name:
Father's Cell:
Father's Business Phone:
Mother's Name:
Mother's Cell:
Mother's Business Phone:
Marital Status:
Child 1 - Registration Information
Full Name:
DOB (MM/DD/YYYY):
Age:
Grade entering Sept., 2011
School:
Weeks attending camp: Check all that apply
If camper has a health problem, is taking medication, had a wrap-around service in school, or if there is any information camp may need to know, please explain:
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Child2 Registration Information
Full Name:
DOB (MM/DD/YYYY):
Age:
Grade entering Sept., 2011
School:
Weeks attending camp: Check all that apply
If camper has a health problem, is taking medication, had a wrap-around service in school, or if there is any information camp may need to know, please explain:
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Child 3 - Registration Information
Full Name:
DOB (MM/DD/YYYY):
Age:
Grade entering Sept., 2011
School:
Weeks attending camp: Check all that apply
If camper has a health problem, is taking medication, had a wrap-around service in school, or if there is any information camp may need to know, please explain:
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Child 4 - Registration Information
Full Name:
DOB (MM/DD/YYYY):
Age:
Grade entering Sept., 2011
School:
Weeks attending camp:Check all that apply
If camper has a health problem, is taking medication, had a wrap-around service in school, or if there is any information camp may need to know, please explain:
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Transportation
Transportation may be available from various areas. If you are interested in transportation for your child(ren), please indicate the area from which your child will need transportation:
Camp Administrative Information:
Camp ages: Ages 4-14. Hours: Monday-Thursday 9:15-4:15, Friday 9:15-2:15. Camp fees: Registration fee - $25 per child, One session of camp - $800, Full summer enrollment - $1500, "By the week" enrollment - $200 per week. Register before March 1st and enter to win 4 free weeks of camp. Achdus Entry Special: Flat rate of $175 per week for ages 4 and 5. Non-refundable, deposit due upon enrollment - $200 per child ($225 total including registration fee), with 50% of balance due by May 1, and remaining balance due before the first day your child attends camp. Call us at 267-456-4532 if you need to request a payment plan. Scholarship available until March 25. Refund Policy: Registration and deposit are non-refundable, 100% of your remaining bill is refundable before May 1, and 50% of your remaining bill is refundable before June 1st. Referral discount: Refer a friend and you both receive $50 off your camp bill (new enrolled camper must attend camp for a minimum of 4 weeks). Transportation available from Philadelphia (stops in the Rhawnhurst and Tomlinson sections), Elkins Park, and Cherry Hill for an addition cost of $40 per week, and from Lower Merion for $30 per week.The Camp reserves the right to refuse or dismiss a camper, or cancel any camper enrollment if either the camper’s personal profile or health history is deemed unsatisfactory, or whose physical or mental condition, conduct, or behavior is deemed unsatisfactory to the best interests of the Camp.
Campers and parents agree to abide by the rules set by the Directors for the health, safety, and welfare of the campers. The Camp is not responsible for the camper’s personal equipment or belongings, while in transit or at camp. The Directors reserve the right to deny, cancel, sever, or suspend a child’s enrollment if deemed in the best interest of the camper or the Camp. The camp officials are authorized to act in my behalf while my child is in their care, including the power to authorize emergency medical treatment. I give permission for my child to take part in all Camp activities and trips and release Camp Achdus from all liabilities for damage or injury.
