Summer Day Camp 2024 - Form - Ohavi Zedek Synagogue

Join in for one or two weeks, August 5-9 and/or August 12-16, 9am-4pm daily.

For campers ages 5-9

Tuition is $350 per camper per week which includes lunch (except field trip days), snacks, field trips and camper t-shirt! Scholarships are available, inquire with Naomi for more information.

Bonus! If a current OZ affiliated family refers an unaffiliated family that enrolls a new camper this summer, both families will receive a camp tuition rebate of $50. One rebate per family!

Please register by June 15.

If you have an OZ Shulcloud account, please log in now, by clicking the "Login" dropdown at the top right of this page. This will automatically populate the form to save you time! (If you don't have an account, you can still register below.)

CAMPER INFORMATION

* How many campers are you enrolling?

* Camper's Full Name

Camper's Pronouns

* Camper's T-Shirt Size

* Camper's Birthdate

* Age of Camper as of August 1, 2023

* Grade in School as of September 1, 2023

* Name of School

Camper's Allergies, Food Restrictions, and Special Instructions:

Any additional information we should know?

Please choose sessions for all your campers:

Week 1, August 5-9

Camper 1Camper 2Camper 3Camper 4

Week 2, August 12-16

Camper 1Camper 2Camper 3Camper 4

Optional Donation to Offset Camp Costs for those in Need?

If Other Amount, Please Enter Here:

Total Amount

PARENT / GUARDIAN INFORMATION

* Parent 1's First Name

* Parent 1's Last Name

* Parent 1's Street Address

* Parent 1's City

* Parent 1's State

* Parent 1's Zip Code

* Parent 1's Email

* Parent 1's Daytime Phone

Parent 2's First Name

Parent 2's Last Name

Parent 2's Street Address

Parent 2's City

Parent 2's State

Parent 2's Zip Code

Parent 2's Email

Parent 2's Daytime Phone

* Child(ren) lives with

Who can we thank for referring you?

EMERGENCY CONTACT INFORMATION

* 1st Emergency Contact's Name

* 1st Emergency Contact's Phone

* 1st Emergency Contact's Relationship

* 2nd Emergency Contact's Name

* 2nd Emergency Contact's Phone

* 2nd Emergency Contact's Relationship

MEDICAL INFORMATION

* Physician's Name

* Physician's Phone

* Health Insurance

* Policy Number

CAMP REGISTRATION WAIVERS

Emergency Medical Care

Emergency Medical CareIn case of accident or serious illness, I request that Ohavi Zedek contact me. If OZ is unable to reach me or if circumstances are urgent, I hereby authorize OZ personnel to seek emergency medial care, including transportation to the emergency room. I hereby authorize the physician in charge to administer whatever treatment necessary at my expense.

Print and Web Publications

Print and Web PublicationsChildren at OZ programs may be photographed and recorded for the purposes of educational enrichment, member engagement and publicity. By giving approval, it is understood that you, as the child's legal guardian, grant permission to Ohavi Zedek Synagogue, its employees and its legal representatives, to publish, without charge, images taken of your child on Ohavi Zedek Synagogue premises or in conjunction with an Ohavi Zedek Synagogue event or for the purpose of an Ohavi Zedek Synagogue publication. These images may be used in any and all Ohavi Zedek Synagogue publications, including electronic materials, website, social media outlets, audio/visual presentations, promotional literature and/or advertising.

* Digital Signature:

Please enter first and last name.