2024 Camp Shemesh ECI

CAMP SHEMESH: (Registration Fee WAIVED through April 5)
- ECI

June 17 - August 9
8:30 AM - 3:30 PM
Aftercare available 3:30 PM - 5:00 PM
Lunch included
Field Trip Shirt (not included)

PARENT INFORMATION:

Parent First Name

Parent Last Name

Cell Phone Number

CAMPER INFORMATION:

* Child's First Name

* Child's Last Name

* Child's Date of Birth

* Entering Grade 2024-2025

EMERGENCY CONTACT INFORMATION:

* Emergency Contact 1 First Name

* Emergency Contact 1 Last Name

* Emergency Contact 1 Phone #

* Emergency Contact 1 Email

Emergency Contact 2 First Name

Emergency Contact 2 Last Name

Emergency Contact 2 Phone #

Emergency Contact 2 Email

AUTHORIZED PICK UP CONTACTS:

The following persons are authorized to pick up my child:

Please write full name as listed on Driver License

CAMPER MEDICAL INFORMATION:

* Insurance Provider

* ID/Group #

* Doctor's Name

* Doctor's Phone #

* Allergies or medical condition

REGISTRATION FEE INFORMATION:

* Registration Fee

Additional $200 Fee for Non-Gordon Families

PRICING INFORMATION:

ECI CAMP

Full Session (8 Weeks)

T-SHIRTS:

$25.00 each (optional for Young Explorer & ECI)

PERMISSIONS

Camp Permissions

My child can participate in sportsMy child can participate in cookingMy child can participate in science & artMy child can participate in gardeningMy child can participate in water days (twice a week)

* Photography/Video/Social Media Release:

YesNo
I agree to allow my child's name, photograph, and information to be used by The Center for Jewish Life at Beth David and The Gordon School in their publications, videos, promotional materials, website and social media without compensation and without prior notice. I release and hold The Center for Jewish Life at Beth David and The Gordon School harmless from any liability stemming from the use of my child's content.

* Insect Repellent & Sunscreen

YES, I will provide products and authorized usageNO, I do not want my child to use these products and I will not provide them
I will provide a new/unopened insect repellent and sunscreen product and give permission for my child's caregiver to apply it to bare surfaces including face, neck, and bare shoulders, arms, legs and feet before outdoor activities. Insect repellent will not be applied to any broken skin or if a skin reaction has been observed. Any skin reaction observed by a staff will be reported promptly to the parent/guardian.

* Immunization & Physical Exam FORMS

Please upload a copy of the pediatrician's immunization forms prior to the first day of camp.

Total

The Center for Jewish Life at Beth David

2625 SW THIRD Ave., Miami, FL 33129