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REGISTRATION APPLICATION

Welcome to the online registration for Camp Achdus 2013. You may register up to six (6) campers using our online application. Please complete all information.

Camp Achdus, Bnos Achdus, Camp Achdus Juniors
Session 1
Week 1: June 24 - June 29 Week 2: July 1 - July 5
Week 3: July 8 - July 12 Week 4: July 15 - July 19

Session 2
Week 5: July 22 - July 26 Week 6: July 29 - August 2
Week 7: August 5 - August 9 Week 8: August 12 - August 15


Please note: Valid registration is a total of $250 per child, which includes a deposit for the first week of camp and registration fee. Once you have completed and submitted the online registration form, you will have the opportunity to submit your payment online for the registration fee and deposit, or you may opt to print out a form to submit with your payment by mail.
Family Information
Family Name :
Father's Name:
Mother's Name:
Home Address:
Home Phone:
Primary Email:
Frequency you check email:
Email 2:
Frequency you check email:
Emergency Contact Numbers during camp hours
Mother's Cell:
Mother's Business Phone:
Father's Cell:
Father's Business Phone:
Grandparents Information
First/Last Name:
Address:
Email:
First/Last Name:
Address:
Email:
Camper 1 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
Camper 2 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
Camper 3 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
Camper 4 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
Camper 5 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
Camper 6 - Registration Information
Full Name:
Gender:
DOB (MM/DD/YYYY):
Age as of June 1st, 2013:
Grade entering Sept., 2013
Weeks attending camp:
Check all that apply 		Week 1   Week 2   Week 3   Week 4
Week 5   Week 6   Week 7   Week 8
Camp Achdus Juniors Only:
T-shirt size (Y=youth, A=adult)
Referred to Camp Achdus by:   
(Enter full name of person who referred you to camp)
 
Transportation
Transportation will be available from various areas. Please indicate your plans for transportation below: (Note:for Camp Transportation, you will be asked to

Check the following if they apply:

 

Terms of Agreement :

1. Advance payment is required throughout the camp season. Campers who have not been paid for will not attend camp.
2. Campers and parents agree to abide by the rules set by the Directors for the health, safety, and welfare of the campers.
3. The Camp is not responsible for the camper’s personal equipment or belongings, while in transit or at camp.
4. 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.
5. I authorize the officials of the camp to act in my behalf while my child is in their care, including the power to authorize emergency medical treatment.
6. 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.

I agree with the terms as stated above (Required)