Camp Wise 2007 Application Form

Online registration is available only if you are paying by credit card. To pay by check, you may download the form and mail it to Camp Wise along with your check.

 
Today's Date:
 
JCC Membership Information
  Non-Member: Member: (member status policy)    
Membership No:
 City: (Member of what JCC)
Renewal Date:  
Camper Information
First Name:
 Last Name:
Female
Address:
 State:
City: Zip:
Home phone:
 Camper Email:
Parent Email(s): Separate multiple emails with commas
Grade in 9/2007: School Attending:
Birthdate: (Example: YYYY-MM-DD)
 

Check if this camper's session is the most expensive of all attending siblings:
If you qualify for the sibling discount, uncheck the box (sibling discount policy).

List names and ages of all siblings attending.
Camper Shirt Size:
 Youth: M L Adult: S M L XL

Attended camp in 2006?: Yes No

This will be my summer at camp. Last Summer Attended:
Synagogue:
Medical Information
 

Please list any extenuating physical or mental health needs:
Family Information
Father

Full Name:

Profession:
Business Phone: Cell Phone:
Address: (if different from child's)
City: State: Zip:
Mother

Full Name:

Profession:
Business Phone: Cell Phone:
Address: (if different from child's)
City: State: Zip:
Family Status: married divorced separated widowed single
Parent with custody: both parents mother father other
Parents alumna/i of Camp Wise: Yes No Name: Year(s):
Grandparents alumna/i of Camp Wise: Yes No Name: Year(s):
Emergency Contact
1) Name and relationship to camper: Phone:

Cell/pager:
2007 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.
  Dates Entering Grades Returning Member* Member** Returning
Non-Member*		 Non-Member
Rishonim I (2w) June 17-July 1 2-5 $1460 $1560 $1730 $1850
Rishonim II (2w) July 1-July 15 2-5 $1460 $1560 $1730 $1850
Chalutzim (4w) June 17-July 15 2-5 $2800 $2995 $3180 $3400
Ohalim (4w) June 17-July 15 6-7 $2800 $2995 $3180 $3400
Noar (4w) June 17-July 15 8-9 $2950 $3160 $3380 $3600
Solel (4w) June 17-July 15 10 $3440 $3680 $3810 $4080
Session II
  Dates Entering Grades Returning Member* Member** Returning
Non-Member*		 Non-Member
Echad (1w) July 17-July 24 2-4 $750 $800 $905 $965
Rishonim III (2w) July 24-August 6 2-5 $1460 $1560 $1730 $1850
Chalutzim (3w) July 17-August 6 2-5 $2230 $2385 $2610 $2790
Ohalim (3w) July 17-August 6 6-7 $2230 $2385 $2610 $2790
Noar (3w) July 17-August 6 8-9 $2380 $2559 $2750 $2940
Solel Tiyul (3w) July 17-August 6 10 $2890 $3090 $3270 $3500
Full Summer
  Dates Entering Grades Returning Member* Member** Returning
Non-Member*		 Non-Member
Chalutzim (7w) June 17-August 6 2-5 $4530 $4850 $4910 $5250
Ohalim (7w) June 17-August 6 6-7 $4530 $4850 $4910 $5250
Noar (7w) June 17-August 6 8-9 $4730 $5060 $5180 $5540
Solel (7w) June 17-August 6 10 $5830 $6240 $6210 $6650
SIT Program (7w) June 17-August 6 11 $800 $800 $800 $800
* 2006 returning campers and their siblings get 2006 rates if registration is post-marked by Oct. 30, 2006. 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)

Charge to Credit Card:
Credit Card Number:
Exp. Date:
Name on Credit Card:

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.)

 

Amount Owed
Cost of Session:
 $
Sibling discount (10%):
- $
Early Bird*
- $
3% Discount
- $
Sponsorship:
+$
Estimated Total:
$
*Before 12/3. Cannot be combined with last year's rate special.

Pay full amount (save 3%).

 

Deposit only. Remaining balance will be applied in three equal payments on November 15, December 15 and January 15 (save 3%).

 
Deposit only. Remaining balance will be applied in three equal payments on January 15, February 15 and March 15.
Your credit card will be billed immediately for the following amount: $

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:

Parent/Guardian Name/Date:

Parent/Guardian Name/Date: