Welcome to Camp Coolanu 2014! Registration Checklist

Transcription

1
Rabbi Melnick
Camp Director
Welcome to Camp Coolanu 2014!
Together for a Summer
of Torah and Fun!
Welcome to Camp Coolanu, located on the beautiful Brauser Maimonides
Academy campus. At Camp Coolanu, we strive to create an atmosphere
where children can create meaningful friendships that will strengthen
their connection to Judaism. We realize that the best time to accomplish
our goal is during the fun-filled days of summer, when children are free
from the stress of school and homework.
We provide campers with dynamic programming, from awesome trips, to
specialty activities, to our memorable dress-up days and prize auctions—
all in a fun and safe environment! This summer’s new highlight is our
better-than-ever specialty activities that are designed to widen your
child’s horizon’s—drama (new!), breakdancing (new!), martial arts, sports,
swimming, arts & crafts, delicious & nutritious eating, creative fun, and
our entertaining Torah lessons! Run by our experienced instructors and
our warm and energetic counselors, your child will leave Camp Coolanu
having discovered a love of Judaism that will last a lifetime!
(Mailing Address)
651 NE 168th st
Registration Checklist
N. Miami Beach, Fl 33162
(Phone) 786-351-0491
(Fax) 954-573-6517
RabbiMelnick@Hotmail.com
The following must be completed before your child is registered in Camp
Coolanu:
o Entire document is properly completed with all signatures
o All post-dated payments are included with your registration
Make sure you fully understand the refund policy before signing. There
will be no exceptions.
CampCoolanu.com
CONTACT INFO: Rabbi Melnick, Tel: (786) 351-0491, E-mail: RabbiMelnick@hotmail.com
th
Please fill out pages 2-9 and send to: Camp Coolanu, 651 NE 168 st, NMB FL 33162, or FAX (954) 573-6517
www.CampCoolanu.com
CAMP COOLANU REGISTRATION 2014
2
MOTHER’S INFORMATION
Last Name:
Home Phone:
Work Phone:
Address:
First Name:
Cell Phone:
E-mail:
City:
Title:
Do You Text?
State:
Zip Code:
FATHER’S INFORMATION
Last Name:
Home Phone:
Work Phone:
Address:
First Name:
Cell Phone:
E-mail:
City:
Title:
Do You Text?
State:
Zip Code:
CHILD #1 INFORMATION
Last Name:
Date of Birth:
Grade Entering:
Address:
Does the Child Live With:
_Both Parents
Friend Requests (not guaranteed):
_Mother
First Name:
_Male
School:
City:
_Father
_Female
State:
Zip Code:
_Other
Last Name:
Date of Birth:
Grade Entering:
Address:
_Both Parents
_Mother
First Name:
_Male
_Female
School:
City:
State:
_Father
_Other
Zip Code:
Last Name:
Date of Birth:
Grade Entering:
Address:
_Both Parents
_Mother
First Name:
_Male
_Female
School:
City:
State:
_Father
_Other
Zip Code:
EMERGENCY CONTACT (OTHER THAN PARENTS)
Name:
Address:
Phone:
Relationship:
City:
Cell Phone:
State:
Zip Code:
PICK-UP ATHORIZATION (OTHER THAN PARENTS)
Name:
Name:
Name:
Relationship:
Relationship:
Relationship:
CAMP REMINDERS
Important camp reminders are sent by email. Please check one choice:
_Please send emails to mother
_Please send emails to father
_Please send emails to both mother and father
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www.CampCoolanu.com
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SECURITY DEPOSIT FORM
Security Deposit: A $100 security deposit per child (or $150 per family) is required along with your payment at the
time of registration. This security deposit will be applied toward extended care, lost/forgotten t-shirts, tipping, and
property damage. Money owed will be deducted from the security deposit. Any remaining balance will be refunded by
mail within one week of your child’s last day of camp.
All parents must maintain a $50 balance in their accounts at all times. If your balance falls below $50, you will be
required to replenish your security deposit to the full amount before your child will be allowed back into camp.
Camp Hours: Camp activities begin at 9:00 (we accept campers as early as 8:45 to accommodate BMA Camp carpool).
Afternoon carpool begins at 3:30 (3:00 on Fridays) and ends promptly at 3:45. Parents dropping off their child before
8:45 or leaving their child past 3:45 (3:15 on Fridays) will be charged for using our extended care service. This charge
will be deducted from the security deposit.
Extended Care: We offer morning care from 7:30-8:45 and aftercare until 5:00. The rates for extended care are not
dependent on how long your child stays during that extended care segment (e.g., 8:00-8:45 am is considered one
extended care segment and, for charging purposes, the cost remains the same whether your child arrives at 8:00 or at
8:44).
Early care for 7:30-8:00 is only offered by prior request. No prior request is necessary for the other extended care
segments.
Parents will be required to sign a form for documentation when dropping off or picking up their child from extended
care.
EXTENDED CARE OPTIONS
Full Morning Care
Partial Morning Care
Full Aftercare
Partial Aftercare
Full Aftercare- Friday
Partial Aftercare- Friday
RATES for EXTENDED CARE
HOURS
RATE/CHILD
7:30-8:45
$10
8:00-8:45
$5
3:45-5:00
$8
3:45-4:30
$5
3:15-5:00
$10
3:15-4:00
$5
RATE/ADDITIONAL SIBLING
$5
$3
$5
$3
$6
$3
Late Pick-up Fee: A late fee of $5 will be assessed at the start of every 10 minute period of arrival past the end of
aftercare; e.g., at 5:01 a parent will already have incurred the first $5 penalty.
Camp T-Shirts: All campers are required to wear Camp Coolanu t-shirts on every trip and while swimming (usually Monday
through Thursday). For safety concerns, this rule is strictly enforced. Campers who forget their camp t-shirt or a change of
clothing after swimming will be given a washed camp shirt. A $5 service fee will be deducted from the security deposit.
Tipping: The recommended tip is $6/counselor and $4/assistant counselor per week of attendance. However, the
mandatory tip is $3/counselor and $2/assistant counselor per week of attendance. If the mandatory tip is not met, the
charge will be deducted from the security deposit.
SIGNATURE
I have read the Camp Coolanu Inc. Security Deposit Form, and I understand and agree to comply with all of the
conditions stated herein.
SIGNATURE OF PARENT OR GUARDIAN __________________________________
Date
/
/_____
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www.CampCoolanu.com
4
REFUND POLICY FORM
There are many reasons why parents may want to withdraw their child from camp—a family obligation, an unexpected vacation
opportunity, a desire to transfer camps, etc. Camp Coolanu’s refund policy has a precise, fixed policy to deal with the above scenarios. Do
not sign below until you fully understand our refund policy. No exceptions will be made. Please contact us with any questions regarding
our refund policy before signing.
Refundable Fees: The initial registration includes a $100 security deposit per child ($150/family); any remaining balance will be refunded
(See Security Deposit Form). Any balance remaining from your child’s canteen account will be refunded.
Non-Refundable Fees: The initial registration payments include a $200 deposit per child, a $75 registration fee per child, and t-shirt
payments that are non-refundable for any reason, irrespective of withdrawal date. In a situation involving partial withdrawal, the $200
deposit will be deducted from the payments made toward the canceled session/week’s fee.
Refundable Dependent on Withdrawal Date: Whether and to what extent the balance of payments (amount paid at registration, minus
above listed refundable and non-refundable fees) is refundable depends on the date of withdrawal from camp. Specifically, the balance
of payments and the remaining security deposit will be refunded in full, up until and including the date two weeks (14 days) prior to the
start of your child’s registered session.
Two applications of our refund policy are as follows: If a child is withdrawn more than two weeks before the first day of camp, then the
st
nd
payments for the 1 and 2 session are refundable, minus the $275 combined deposit, registration fee, and t-shirt payments per child. If
nd
a child is registered for both sessions, and is withdrawn less than two weeks before the first day of camp, only the payments for the 2
session are refundable, minus $275, t-shirt payments, and optional extended care payment.
Additional Refund Policies: There are no refunds for sick or other missed days. If camp is forced to close due to inclement weather
(hurricane, tropical storm, flood, etc.), national emergency, or power outage, fees cannot be refunded. Camp will resume the day after
power has been restored.
SIGNATURE
I have read the Camp Coolanu Inc. Refund Policy Form, and I understand and agree to comply with all of the conditions
stated herein.
SIGNATURE OF PARENT OR GUARDIAN _______________________________________
Date
/
/_____
RELEASE OF LIABILTY FORM
My child(ren) has/have my permission to participate in all scheduled and unscheduled camp activities and events at or associated with
Camp Coolanu Inc. I understand that this program will include field trips off the premises, such as swimming at the YMCA (located
at 3161 Taft Street, Hollywood, FL) or another pool, CB Smith Paradise Cove Water Park, TY Water Park/ Castaway Island, Calypso Cove
Water Park, Uncle Bernie’s Amusement Park, The Wow Factory, The Miami Children’s Museum, Kabooms, Carnival Funsation, Chuck E.
Cheese’s, Off the Wall Trampoline Fun Center, Sparez Bowling, and more. To see a list of scheduled trips and activities, please see
www.campcoolanu.com; trip dates are subject to change.
I, the parent/guardian, assume all risks and hazards incidental to or resulting from the negligence of Camp Coolanu Inc., its employees,
owners, volunteers, or sponsors before, after, or during camp activities and transportation to and from activities and any other
programing or event. I do hereby release and hold harmless Camp Coolanu Inc. and/or the organizers, sponsors, supervisors, volunteers,
and anyone connected with the program or activity for any injury resulting from any and all said negligence.
I understand and agree that Camp Coolanu Inc. and its owners, staff, and volunteers are not responsible for any injuries negligently
suffered while participating in camp activities.
NAME OF CHILD(REN) ____________________________________________________________________
NAME OF PARENT/GAURDIAN _____________________________________________________________
SIGNATURE PARENT/GAURDIAN ______________________________________________
Date
/
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www.CampCoolanu.com
/_____
List only One Child per form
(print additional forms if needed)
MEDICAL FORM
5
Child Last Name:
Date of Birth:
PHYSICIAN’S NAME:
Office Address:
Phone:
Child First Name:
_Male
_Female
Date of last Physical:
PERSONAL HEALTH HISTORY
Childhood Illnesses:
_Measles
_Mumps
_Rubella
_Chickenpox
_Rheumatic Fever
Other____________________
List Any Medical Problems:
_Polio
ALLERGIES
Child is Allergic to:
Reaction:
Treated with:
GENERAL QUESTIONS
Is your Child Taking any Specific Medication?
If YES, Please Specify:
Does your Child have any Heart Problems?
Does your Child have any Breathing Problems?
Did your Child Ever Suffer from any Severe Injury or Accident?
Date of Last Tetanus Booster:
_Yes
_No
_Yes
_Yes
_Yes
/
_No
_No
_No
/
MEDICATION/TREATMENT
To permit Camp Coolanu Inc. to administer over-the-counter or prescription medication to your child, please complete the
following forms found on the camp website (www.campcoolanu.com):
1. Parental Authorization for Medication/Treatment
2. Physician Authorization for Prescription Medication/Treatment
HEALTH INSURANCE
I have the following Health Insurance:
Company Name: ____________________________________Policy #__________________________________
SIGNATURE
I declare that I have provided Camp Coolanu Inc. with all information regarding my child’s health, which may reasonably be
needed to meet the medical and/or physical needs of my child. I further agree that I can be reached at the telephone
number(s) I have provided during the hours my child is at camp. If an emergency arises, and none of the above numbers can
be contacted for any reason, I hereby authorize Camp Coolanu Inc. to seek emergency medical treatment administered by,
but not restricted to, paramedics, hospital emergency room employees, and/or other medical professionals as reasonably
necessary for the emergency medical treatment of my child. I hereby release Camp Cooolanu Inc. and its staff members from
any liability resulting from any medical services provided and agree to pay for such services upon invoice.
SIGNATURE OF PARENT OR GUARDIAN _________________________________________
Date
/
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www.CampCoolanu.com
/_____
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CAMP POLICY FORM
CARPOOL & CAMPER RELEASE
*Morning carpool runs from 9:00-9:15. Afternoon carpool runs from 3:30-3:45 pm (3:00-3:15 on Fridays). If you arrive at any
other time, you must escort your child to/from the office.
*To release your child to anyone besides yourself or your designee, prior arrangements must be made with the Camp Director,
Rabbi Melnick. Proper identification must be shown every time your child is picked up.
TRIPS AND EXCURSIONS
*Children must be seated with seatbelts fastened on all bus rides. Due to safety concerns, any child unwilling to comply with
this rule may be sent home for the day.
*Departure for trips and outings will be kept on schedule. If you are late, please meet us at our destination.
SWIMMING
It is the responsibility of the parent(s) to apply sunscreen to their child(ren) before camp.
CAMP T-SHIRTS
*Camp t-shirts must be worn on trip days (usually Mon & Wed)
*Campers must swim in camp t-shirt (Tues & Thurs)
*The cost is $10/ shirt (no shirts available for purchase after registration)
*One new shirt is required; previous camp shirts may be worn.
*Shirts may not be exchanged for a different size (sample shirts will be available at the BMA office and at JUMP).
*Campers who forget their camp t-shirt or a change of clothing for after swimming will be given a washed camp shirt (a $5
service fee will be deducted from the security deposit).
UNRULY BEHAVIOR
The Camp Director reserves the right to terminate or suspend any camper or deny his/her participation in any activity, if
his/her conduct, influence, or behavior is deemed unsatisfactory as deemed by the Camp Director.
CAMPER LIABILITY
Parents will be responsible for paying for any property damage caused by their child(ren).
CELL PHONES
Campers are not permitted to use their phones (to call or send/receive texts) on campus or on outings; phones will be
confiscated and brought to the camp office for parents to pick up. Camp Coolanu Inc. will not be responsible for confiscated
phones.
PERSONAL PROPERTY
*Write your child(ren)’s name on all belongings.
*Camp Coolanu Inc. does not take responsibility for any items brought to camp.
*Campers are not permitted to bring expensive belongings to camp (toys, DSIs, gaming systems, etc.). Any damage to such
items brought onto camp property in contravention of this rule will be the responsibility of the parents.
LUNCH & SNACKS
Tuition includes lunch and a snack. Snacks brought from home must be in original packaging with an Orthodox-approved
kosher symbol. For a list of approved symbols, see the Chicago Rabbinical Council website.
PARENT HANDBOOK
Parents must read and agree with all policies stated in the Parent Handbook http://www.campcoolanu.com/manual.php
TIPPING
*The recommended tip is $6/counselor and $4/assistant counselor per week of attendance.
*The mandatory tip is $3/counselor and $2/assistant counselor per week of attendance (if amount not met, the charge
will be deducted from the security deposit).
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CAMP CLOSED FRI, JULY 4
STUDENT ACCIDENT INSURANCE
Claim must be filed with camper’s primary carrier, and only the unpaid portion can be submitted to the student accident
carrier, subject to a $100 deductible and a maximum of $10,000. Written notice of claim must be given to Camp Coolanu Inc.
within 14 days after accident.
Please
Initial
X
X
X
X
X
X
X
X
X
X
X
X
SIGNATURE
I have read the Camp Coolanu Inc. Camp Policy Form, and I understand and agree to comply with all of the conditions stated
herein.
SIGNATURE OF PARENT OR GUARDIAN ______________________________________
Date
/
/______
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www.CampCoolanu.com
7
T-SHIRT ORDER FORM
1
Complete number of EXTRA t-shirts2 to order (if not ordering extra, just check size):
___S(6-8)
1
___M(10-12)
___L(14-16)
Do not include the 1 required shirt
2
___Adult S
Shirts run small
Camp t-shirts must be worn on all trips and while swimming.
The cost is $10/ shirt (no shirts available for purchase after registration.)
One new shirt is required; previous camp shirts may be worn.
Shirts may not be exchanged for a different size.
Sample shirts will be available at the BMA office and at JUMP to be tried on for size.
Include payment with registration, see Payment Instructions table, pg. 7
CANTEEN FORM
CHECK CHOICE(S):
o I give my child permission to purchase any snack from the canteen.
o I give my child permission to purchase only chocolate & ice cream.
o I give my child permission to purchase only drinks.
o I do not give my child permission to purchase any snacks.
Comments_______
______________________
CANTEEN ACCOUNT (OPTIONAL):
To prevent campers from losing their canteen money, we recommend going cashless. To deposit money into your child’s
canteen account, payment must be submitted with registration. Balance of canteen account is refundable.
Amount to Deposit in your Child’s Canteen Account: $____________ Daily Spending Limit: $____________
VOLUNTEER INTEREST FORM
Please check trips for which you are interested in chaperoning:
Uncle Bernies Amusement Park
O Yes O No O Maybe
Ft. Lauderdale Museum of Discovery & Science (Exhibit) O Yes O No O Maybe
CB Smith Paradise Cove Water Park
O Yes O No O Maybe
SWIMMING FORM
Name of Child # 1 ____________________________ O Child knows how to swim. O Child does not know how to swim.
PHOTO RELEASE FORM
Camp Coolanu Inc. is hereby granted permission to use any photo or video of my child involved in camp activities for camp
promotional or other materials.
NAME OF PARENT/GAURDIAN _____________________________________________________________
SIGNATURE OF PARENT OR GUARDIAN ______________________________________
Date
/
/______
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8
PAYMENT FORM—EARLY BIRD RATE
DATES
st
nd
1 SESSION
3 WEEKS (Jun 16th – Jul 3d)
2 SESSION
4 WEEKS (Jul 7th – Aug 1st)
FULL SUMMER
7 WEEKS (Jun 16th –Aug 1st)
AGES, TUITION, & DEADLINES
AGES ENTERING K-5
BASE TUITION (SESSION RATE) $210/WEEK (EARLY BIRD)
$220/WEEK (REGULAR RATE)
SINGLE WEEK RATE: $225 (EARLY BIRD)/ $235 (REGULAR RATE)
*additional payments apply, see Payments Required table below*
ADDITIONAL DISCOUNTS Full Summer Discount (~5%) Additional Sibling Discount (~5%)
EARLY BIRD DEADLINE: Tues, Apr 1st
REGISTRATION DEADLINE FOR 1ST SESSION: Mon, Jun 2nd
st
nd
(NO campers accepted for the 1 session after June 2 )
PAYMENTS REQUIRED
PAYMENTS DUE AT REGISTRATION
Tuition Deposit
AMOUNT
$200/child
(non-refundable; credited to the last session registered or canceled session/weeks)
All Post-Dated Checks for Remaining Tuition
$190-$235 per week
(see dates in table; dependent on # of registered weeks & sibling discount)
Registration Fee (non-refundable)
$75 single child; $150 family
Security Deposit (balance is refundable)
$100 single child; $150 family
T-Shirt Fee
(non-refundable)
$10/child per t-shirt + any extra t-shirts
Canteen Payment—Optional (refundable)
No specific amount
All post-dated checks must be submitted with your registration payments. Your child will not be registered if any
portion is missing. Payment instructions are listed in the table below.
*Make all checks payable to “Camp Coolanu” *Bank fee will be charged for all returned checks.
PAYMENT INSTRUCTIONS: EARLY BIRD
Check One SESSION #
Choice
1st, 2nd
1st, 2nd
1st, 2nd
1st
1st
1st
2nd
2nd
2nd
Date:
Date:
Date:
1 Week
1 Week
1 Week
# KIDS PAYABLE AT
REGISTRATION
1
$385 + extra t-shirts
2
3
1
2
3
1
2
3
1
2
3
$1,110+extra t-shirts
6/3/13
6/24/13 SUB-TOTAL $10/EXTRA T-SHIRT TOTAL DUE
Post-Dated Post-Dated
$600
$1170
$1,740
$430
$830
$1,230
$600
$1,160
$1,720
NA
NA
$640
$1,240
$1,840
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
PAYABLE AT REGISTRATION
$1,585
$3,050
$4,390
$815
$1,550
$2,160
$1025
$1,960
$2,770
$360
$720
$1080
CALL for
out-of –
session
instructions
PROMISSORY NOTE
In exchange for a reserved camper slot, the undersigned (MAKER) promises to pay to the order of Camp Coolanu Inc. (PAYEE) the
balance owed, as calculated through the use of the Payment Instructions: Early Bird table above, which includes the total cost of the
registered sessions or weeks, registration fees, and any additional T-shirts. All camp fees must be paid at the times stated above in
the Payment Instructions: Regular Rate table, or your child will automatically lose his/her reserved camp spot.
SIGNATURE OF PARENT OR GUARDIAN _____________________________________
Date
/
/
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www.CampCoolanu.com
9
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www.CampCoolanu.com

Welcome to Camp Coolanu 2014! Registration Checklist

Transcription

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