Camp Neshama Registration

Camp Neshama 2021
Payment
Review

Section

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 no later than June 1st.

A non-refundable deposit of $250, payable online and applied towards the total camp fees, will be charged with the registration.

Camp runs for 8 weeks, from June 28 to August 20 (closed July 5), Monday through Friday, from 8:30 am to 3:30 pm. You may register 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*

Gender*

Grade in September*

Address*

City*

State*

Zip Code*

Parent/Guardian 1

First Name*

Last Name*

Email*

Home Phone*

Cell Phone*

Work Phone

Parent/Guardian 2

First Name

Last Name

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*

Phone Number*

Name

Relation to Child

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. If there are none, please acknowledge this by entering "N/A" or "none" in the fields below.

Allergies*

Medical Condition(s) and/or Physical Limitation(s)*

Camp Fees

8 Weeks, earlybird by 2/1/21 = $2,200

8 Weeks, from 2/2/21 - 5/31/21 = $2,500

8 weeks, 6/1/21 and later - $2,625

4 Weeks = $1,500

Individual Weeks = $375 each

Sibling Discount (cannot be combined with earlybird) = 10%

Camp Sessions

Please select the number of weeks your child will be attending below. Then select which weeks they will be attending. For example, if your child will be attending all 8 weeks, check all of the weeks on the list.

# of Weeks Attending*

Payment Schedule

$250 non-refundable registration fee, due with application and applied towards total camp fee

$500 due by 5/1/2021

Balance due by 6/1/2021

Please make checks payable to GRTWA and 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*