Camp Chaverim Boyz Application

Camper information
Transportation
Terms & Conditions
Payment

Parent information

Family Name

Home Phone

Summer Phone

Father's Name

Father's Cell

Mother's Name

Mother's Cell

Street

City

State

Zip

Lunch Form Upload

Please download the lunch form. You will need to fill it out and upload it to continue with the registration

Number of members in the household (including parents and children living in the household)

Are you currently enrolled with SNAP/TANF/FDPIR?
Yes No

Please list in Part 1 the children coming to our camp and put in Part 2 the case number. Then sign in Part 4 and upload it.

Please follow the instructions in the form. List in Part 1 the children coming to our camp, skip Part 2 if you're not enrolled with a case, and fill out Part 3 making sure to list ALL members in the household. Then sign Part 4 with the last 4 digits of your SSN.

Upload Completed Lunch Form (Required)

Upload

(Max file size is 2M)

Camper information

Name your child is called

Boy's Legal Name

Date of Birth

Age

I Am Applying For

Has He Attended Camp Chaverim Boyz Before?

What yeshiva is your son attending?

Rebbe's Name

Principal or Rebbi`s Phone Number

Kita Attending in HIS Yeshiva:

Did He Start/Starting Learning Gemara?:

T-shirt Size (for free t-shirt)

Name on T-Shirt (Up to 11 chars)

Bunk or class request (choose 3 boys in order of priority; only one is guaranteed. New bunks are created every year. If 'none' is entered, we will place campers with a colony mate by default)

Does Your Child Have Any Allergies?

My Child Is Allergic To:

Photo Of Camper

Upload

(Max file size is 2M)

Medical Form

Please upload your sons medical form here:

Upload Medical Form

Upload

(Max file size is 2M)

The registration is incomplete until the medical form is received
Email: [email protected]
Fax: 833-233-3085

Transportation

I would like transportation from:

Name of colony:

Exact Address

City

State

Zip

Please contact rabbi Kohn at 347-685-3875 to make sure we have transportation from there.

Terms & Conditions

Liability Waiver and Release Agreement

It is the purpose of this agreement to exempt, waive and relieve the Releasees from any and all liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any of Releasees for the transportation to day camp, and for any time during camp hours.

“Releasees” include Chaverim Boyz its event hosts, other participants, chaperones, sponsors, drivers, and each of them, their officers, directors, agents and employees.

For and in consideration of the undersigned Participant’s being allowed to participate in Chaverim Boyz events and activities, Participant (and the parent(s) or legal guardian(s) of Participant, if applicable) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to Participant, arising out of participation in Chaverim Boyz events and activities.

Chaverim Boyz and/or activities incidental thereto, whenever or however they occurs and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that Participant (and the parent(s) or legal guardian(s) of Participant, if applicable) may have are hereby waived, released and relinquished, and Participant (and the parent(s) or legal guardian(s) of Participant, if applicable) does (d) so on behalf of my/our and Participant’s heirs, executors, administrators and assigns.

Participant (and the parent(s) or legal guardian(s) of Participant, if applicable) acknowledge that they have retained a copy of this Liability Waiver and Release Agreement, have read it and understand it, and further acknowledge that in signing this document, they have not relied upon any representatives of Releasees. The parties expressly agree that this Liability Waiver and Release Agreement is intended to be as broad and inclusive as permitted by the laws of the State of New York.

I wish to enroll my child(ren). I have read this application form and agree to all the conditions listed.

The undersigned is the Parent or Legal Guardian of

Parent/Guardian Name (Print):

Signature

Date

Payment

Current Price:

Full summer $2,099. Half a summer $1,280. (Goes up on June 1st)

After June 1st:

Full summer $2,199. Half a summer $1,380.

There is a registration fee of $50 per camper and a transportation fee of $200 per half. $400 for full summer.

Includes a free personalized CB T-shirt!

No additional charges for lunch and trips.

From June 1st, registration is non-refundable and must be paid in full at time of registration.

Total: $

Administrative code (if given by the administration)

Please Select Payment Method:

Credit Card (A 2.75% fee will be added to to all credit card payments, to defray our cost)

Check

Please Select Payment Options:

Pay in Full

Pay deposit today, pay remaining balance in instalments on May 15, June 15

Card Details

Amount

Name On Card

Zip Code

Card Number

Expiry Date

CVV

Early Bird price: $ $

Terms and Conditions:

                TERMS AND CONDITIONS:

                1. Full camp tuition payment is required before the camp season begins. We reserve the right to apply additional fees for repeated late payments or for payments that are significantly overdue.

                2. Installment plans are available, the earlier the registration the more installments there are with the option ending June 1st.

                3. Installment plans are conditional to successful payments.

                4. Unsuccessful Recurring Payment:
                If an installment payment is unsuccessful and unresolved within 48 hours of the scheduled date, the balance must be paid in full to keep the registration active.

                5. Declined payments will incur a $10 fee per occurrence. Payments will be retried every 48 hours from the original recurring payment date.
                6. A $25 fee will be charged for returned checks.
                7. A non-refundable deposit of $550 is required upon registration.

                8. Cancellation policy: Cancelation requests after June 1st will not be honored. Cancellation before June 1st will be refunded minus the deposit.

                9. Registration changes, switching from full to half, will be accommodated subject to the current price at the time of the change. After June 1st, no refunds will be issued for any changes made to registrations.
                10. Extending camp sessions after camp starts will be accommodated based on availability: during the first two weeks of camp at the full summer current price, and after that, a new registration for the second half is required at the current half-session price (no adjustment to the full summer price will be made).

                11. Last-minute registrations (June 1st and on) are non-refundable.
                12. Application Acceptance: We reserve the right to accept or decline any application at our discretion.

                13. Transportation: Additional transportation fees may apply for long-distance routes, dependent on the number of campers.

I agree to the above terms and conditions

Text

Liability Waiver and Release Agreement

Please Select Payment Method:

Please Select Payment Options:

Card Details

Check Details

Welcome to Camp Chaverim!