INTRODUCTION
Complete this form to register your child for Camp Neshama. Please note the following:
- A separate registration form is required for each child.
- You will need to submit a completed Universal Health Record and list of immunizations before camp begins.
- Fields marked with an asterisk in the registration form are required.
- Camp runs for 8 weeks, from June 27 to August 19 (closed July 4), Monday through Friday, from 9:00 am to 3:00 pm (Friday at 2:30 pm).
- You may register your child for the full 8 weeks, a 4-week session, or individual weeks.
For any questions about the camp or registration, please contact Shari Kalter at [email protected] or at 973.584.5530, ext 3017.
CHILD'S INFORMATION
*First Name
Nickname
*Last Name
*Date of Birth (MM/DD/YY)
*Gender
*Grade in September
*Address
*City
*State
*ZIP
PARENT/GUARDIAN 1
*First Name
*Last Name
*Title
*Home Email
*Home Phone
*Cell Phone
Work Phone
PARENT/GUARDIAN 2
First Name
Last Name
Title
Address (if different than child's)
City
State
ZIP
Home Email
Home Phone
Cell Phone
Work Phone
PICKUP AUTHORIZATION
Please enter below the names of anyone, other than parent, authorized to pick up your child. Unless written notice is given, these are the only people to whom we will release your child.
Name
Cell
Name
Cell
Name
Cell
EMERGENCY CONTACTS
Please enter at least one emergency contact, other than parent, below.
*Name
*Relation to Child
*Best Phone Number
Name
Relation to Child
Best Phone Number
MEDICAL INFORMATION
Please enter your child's doctor's information.
*Doctor's Name
*Doctor's Phone Number
Please list below if your child has any allergies, medical conditions. or physical limitations.
Allergies
Medical Condition(s) and/or Physical Limitation(s)
CAMP FEES
- 8 weeks = $2,575
- 4 Weeks = $1,500
- Individual Weeks = $400 each
- Sibling Discount = 10%
CAMP SESSIONS
Please check below the weeks your child will be attending camp. You must check at least one box, and your fee will be determined by the number of weeks you choose based on the above chart.
June 27-July 1
July 5-8 (no camp July 4)
July 11-15
July 18-22
July 25-29
August 1-5
August 8-112
August 15-19
PAYMENT SCHEDULE
- $250 non-refundable registration fee due with application (applied toward camp tuition fee)
- $500 due by 5/1/2022
- Balance due by 6/1/2022
Please make all checks payable to GRTWA and either hand-deliver or mail to the following address:
Gottesman RTW Academy
Attention: Camp Neshama
146 Dover Chester Rd
Randolph, NJ 07869
CONDITIONS OF REGISTRATION
In order for a child’s registration to be accepted for Camp Neshama, parents must agree to the following conditions and indicate their agreement by typing their name in the appropriate field below.
PUBLICITY AUTHORIZATION: I grant permission for my child’s picture to appear on the GRTWA website, Facebook page, and Twitter feed and in any GRTWA materials prepared for, by, or on behalf of Camp Neshama to advertise or promote its ECC, summer camp and/or school activities.
MEDICAL AUTHORIZATION: In the event that my child requires medical care (and the determination thereof shall rest solely with GRTWA personnel if they are unable to reach me) I authorize any doctor or doctors and/or hospital to which my child may be brought to take and perform all necessary procedures and render any indicated treatment, including the administration of anesthesia if needed, and the performance of an operation if in the opinion of said doctor or doctors the same is necessary, while such child is under the jurisdiction of Camp Neshama.
ENROLLMENT AGREEMENT: I hereby enroll my child in Camp Neshama. I agree to pay GRTWA the fees listed above. I understand that failure to pay the said fees may result in the termination of my child’s enrollment in the program.
*Sign here by typing your full name
*Date
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