Camp Neshama Registration

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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 skalter@grtwacademy.org 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 111-15
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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