2020 Camp Keshet Registration
Child's Information
Child's Last Name
Child's First Name
Are you a member of PAS
Yes
No
Child's Gender
Male
Female
Camper Status
New Camper
Returning Camper
Returning Camp Family
Child's Birthdate
Child's Group Eligibility
Group A (9:30am-1pm): Children with birthdays from 5/1/17-5/31/18
Group B (9:30am-1pm): Children with birthdays from 7/1/16-4/30/17
Group C (9:30am-3pm): Children with birthdays from 2/1/15-6/30/16
Address
City
State
Zip Code
Home Phone Number
What school (if any) did your child attend in 2019-2020?
What school (if any) will your child attend in 2020-2021?
Does your child have food allergies?
Yes
No
Please list your child's allergies:
Camp t-shirt size
3T
4T
Youth XS
Youth S
Does your child require special services or have an Individualized Education Program (IEP)?
Yes
No
Please explain:
How did you hear about Camp Keshet?
Family Status
Parent's are...
Married
Partnered
Divorced
Separated
Widowed
Single
Parent with Custody
Both Parents
Mother
Father
Other
Parent #1 Information
First Name
Last Name
Address
City
State
Zip Code
Email Address
Home Phone Number
Work Phone Number
Cell Phone Number
Parent #2 Information
First Name
Last Name
Address
City
State
Zip Code
Email Address
Home Phone Number
Work Phone Number
Cell Phone Number
Groups A and B - Member
How many weeks will your child be attending?
4 Weeks - $3600
5 Weeks - $4500
6 Weeks - $5400
Groups A and B - General
How many weeks will your child be attending?
4 Weeks - $4000
5 Weeks - $5000
6 Weeks - $6000
Group C - Member
How many weeks will your child be attending?
4 Weeks - $4000
5 Weeks - $5000
6 Weeks - $6000
Group C - General
How many weeks will your child be attending?
4 Weeks - $4800
5 Weeks - $6000
6 Weeks - $7200
Incomplete application and those not accompanied by payment in full will not be accepted.
Campers must be enrolled for any 4 CONSECUTIVE WEEKS.
**Any changes made to your child's dates of attendance after May 15th will incur a change fee of $50**
Which weeks will your child attend? Campers must attend for a minimum of 4 weeks.
June 22-June 26
June 29-July 3
July 6-10
July 13-17
July 20-24
July 27-31
*9-3 classes end at 1pm on Fridays.
*All classes end at 12pm on the last day of camp.
* There is no camp July 3.
Enrollment and Refund Policy:
A health form, completed by your doctor, must be on file before your child can start camp. Camp Keshet is not responsible for providing make-ups or issuing refunds for camp days as a result of scheduling conflicts, illness, emergencies, or other events beyond our control. The camp deposit of $500 is non-refundable once you have been accepted into the camp.
If a child is withdrawn from camp before the end of the session by parents or guardians, no refund will be given.
There is no pro-rated fee for campers arriving after the start of a week or leaving before its completion.
Total Cost
Total Registration
$
Credit Card Information
First Name on Card
Last Name on Card
Credit Card Number
Exp Month
Exp Year
Security Code
Billing Address
Billing City
Billing State
Billing Zip Code
Release: I hereby give my permission for my child to participate in all programs, swimming activities and trips as part of the 2020 Camp Keshet program. I hereby release Camp Keshet, the Park Avenue Synagogue, or any of its sponsors, benefactors or employees from any liability arising out of any injury to my child. In the event of a medical or surgical emergency, I grant permission to Camp Keshet to hospitalize, secure proper treatment for and order injections, anesthesia or surgery for my child. Furthermore, I understand that payment for medical services is solely the family's responsibility. I permit Camp Keshet/Park Avenue Synagogue to use my child's photos or quotations for publicity purposes.
I have read and agree to this statement
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Contact Information