Family Information
Family Name :
Father's Name:
Mother's Name:
Home Address:
Home Phone:
Primary Email:
Frequency you check email:
Multiple times a day
Daily
Weekly
Email 2:
Frequency you check email:
Multiple times a day
Daily
Weekly
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:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Camper 2 - Registration Information
Full Name:
Gender:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Camper 3 - Registration Information
Full Name:
Gender:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Camper 4 - Registration Information
Full Name:
Gender:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Camper 5 - Registration Information
Full Name:
Gender:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
Referred to Camp Achdus by:
(Enter full name of person who referred you to camp)
Camper 6 - Registration Information
Full Name:
Gender:
Male
Female
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:
Partial Day (9:15am - 2:15pm)
Full Day (9:15am - 4:15pm)
T-shirt size (Y=youth, A=adult)
YXS
YS
YM
YL
AS
AM
AL
AXL
AXXL
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
complete Transportation Sign up form in Registered Camper Packet)
Carpool
Camp Transportation
Check the following if they apply:
We registered before March 8th and would like to be entered to win 4 FREE WEEKS OF CAMP.
We are interested in information about a late care program from 4:15pm - 6:15pm.
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)