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Today's Date: |
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| JCC Membership
Information |
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Non-Member
Member (member
status policy) |
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| Membership
No: |
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City: |
(Member of what
JCC) |
| Camper Information |
First Name: |
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Last Name: |
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Birthdate:
(YYYY-MM-DD) |
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Address: |
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State: |
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| City: |
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Zip: |
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Home phone: |
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| Parent Email(s): |
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Separate multiple emails
with commas |
Camper Email: |
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| Grade in 9/2008: |
School Attending: |
| Synagogue: |
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Attended camp in 2007?: Yes
No
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If
you qualify for the sibling discount, check the box (sibling
discount policy):
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| Camper Shirt Size: |
Youth:
M
L  Adult:
S
M
L
XL |
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| This will be my
summer at camp. Last Summer Attended:
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Medical Information |
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Please list any extenuating physical
or mental health needs:
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| Family
Information |
| Parent
1 |
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Birthdate: |
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| Business Phone: |
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Cell Phone: |
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| Address: |
(if different from child's) |
| City: |
State:
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Zip: |
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| Parent
2 |
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Birthdate: |
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| Business Phone: |
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Cell Phone: |
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| Address: |
(if different from child's) |
| City: |
State:
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Zip: |
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| Parent 1 Profession: |
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Parent 2 Profession: |
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| Family Status:
married
divorced
separated
widowed
single |
| Parent with custody:
both parents
mother
father
other |
| Parents/Grandparents alumna/i of Camp Wise: |
Yes
No |
Name:
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Year(s):
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| 2008 Prices |
| Session I |
This section will use the current
date, the JCC membership status and if your child is a previous
camper above to select the correct price. The price will be filled
in the "Amount Owed" section below for reference. |
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| Session II |
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| Full Summer |
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* 2007 returning campers
and their siblings get 2007 rates if registration is post-marked
by Oct. 30, 2007. Cannot be combined with early bird discount.
** Member rates includes members of any JCC and anyone who lives
more than 40 miles from a JCC.
Other Discounts may apply, please
read attached policies. |
| Payment Information |
| A
refundable deposit of $500 must
accompany each camper's registration form and is necessary to
reserve space at Camp Wise for your child
(read
refund and payment policies here)
I would like to receive a confidential
application for financial assistance. Please only charge my credit
card $100 to hold my child's space. (Applications for financial
assistance must be submitted by January 15th and are granted
on a first come, first served basis. As a scholarship recipient
no other discounts apply.) |
*Before 12/3. Cannot be combined with
last year's rate special. |
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Your credit
card will be billed immediately for the following amount: $
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Sponsor
A Camper
Please add the following amount to my fees
to help send a child to Camp Wise:
$18
$54
$144
Other (enter amount) |
| Parental
Agreement |
| We understand and recognize
that there is always an inherent risk of bodily injury and harm
associated with camping, horseback riding, boating activities,
swimming, challenge rope courses, archery, and other camping
activities. No warranties or representations of any kind have
been made by the Jewish Community Center of Cleveland, its employees,
agents, officers, directors, trustees, successors, or assigns
regarding the activities of Camp Wise.
Signature of ths Waiver
and Release means that we and our child hereby personally assume
all risks in connection with our child's participation in and
attendnace at Camp Wise and in connection with participation
in any and all Camp Wise activities. We waive and release the
Jewish Community Center of Cleveland, its officers, trustees,
employees and volunteers, as well as any of its sponsors and/or
affilliates from any and all claims relating to our child's
attendance at Camp Wise, or his or her participation in any
related Camp Wise activities, unless caused by gross negligence
or willful misconduct of any such person or entity.
I have read and agreed to all Camp Wise Policies
attached to this application:
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Parent/Guardian Name/Date:
Parent/Guardian Name/Date:
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