Camp Rodeph Sholom

Upcoming Sessions

1. Monday, July 20, 2020 • 28 Tammuz 5780

2. Tuesday, July 21, 2020 • 29 Tammuz 5780

3. Wednesday, July 22, 2020 • 1 Av 5780

4. Thursday, July 23, 2020 • 2 Av 5780

5. Friday, July 24, 2020 • 3 Av 5780

6. Monday, July 27, 2020 • 6 Av 5780

7. Tuesday, July 28, 2020 • 7 Av 5780

8. Wednesday, July 29, 2020 • 8 Av 5780

9. Thursday, July 30, 2020 • 9 Av 5780

10. Friday, July 31, 2020 • 10 Av 5780

Register

CAMP RODEPH SHOLOM 2020
July 20-24 and July 27-31 

9:00 a.m. - 3:00 p.m.*
*(Before or after care available)

*One application per camper.

* Camper's Full Name

* Birth Date

Grade in Sept 2020

Age

* Address

* City

* State

--Select State--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

* Zip Code

Parent #1: Name

Parent #1: Email

Parent #1 Cell Phone

Parent #1 Work Phone

Parent #1: Home Phone

Parent #2 Name (N/A if not applicable)

Parent #2: Email

Parent #2 Cell Phone

Parent #2 Work Phone

Parent #2 Home Phone

INFORMATION:

• CAMP SESSION IS WEEKDAYS FROM MONDAY, JULY 20TH - FRIDAY, JULY 24TH AND MONDAY, JULY 27TH - FRIDAY, JULY 31ST. 
• CAMPERS SHOULD BRING A CHANGE OF CLOTHING FOR MESSY ACTIVITIES.  DAILY SCHEDULE WILL BE SENT OUT IN MAY.
• ANY MEDICATIONS SHOULD BE LABELED AND THE WRITTEN INSTRUCTION SHEET MUST BE COMPLETED.
• KOSHER LUNCHES MAY BE PURCHASED EACH DAY OR YOU MAY PACK A DAIRY OR VEGETARIAN LUNCH.  LUNCH ORDERS LISTED BELOW ARE $5.00 PER DAY.  SNACKS WILL BE PROVIDED DAILY.

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Camp Tuition

Members: ($420) July 20-24 AND July 27-31Non-members: ($470) July 20-24 AND July 27-31Members: ($275) July 20-24 (1 week)Non-Member: ($320) July 20-24 (1 week)Member: ($275) July 27-31 (1 week)Non-Member ($320): July 27-31 (1 week)

Lunches $5.00/day

Monday, July 20 - Spaghetti (sauce or butter)Tuesday, July 21 - Hot Dog & ChipsWednesday, July 22- Cheese Quesedillas & Corn chips and salsaThursday, July 23 - PizzaFriday, July 24 - Fish Sticks & French FriesMonday, July 27 - Macaroni & CheeseTuesday, July 28 - Grilled Cheese & Corn on cobWednesday, July 29 - Fish Sticks & Tator TotsThursday, July 30 - Hot Dog & ChipsFriday, July 31 - PizzaLunches include salad or vegetable, entree, and fruit.  PBJ or Bagel can be substituted if requested.
 

PBJ or Bagel with cream cheese or butter - Alternative

Please note any days and substitutions for the lunches ordered.

Extended Care (Enter Number of Days needed)

012345678910   Extended Care AM (730-900AM) $3/Day

012345678910   Extended Care PM (3:00pm - 6:00pm) - $9/dayPlease select the number of days you would like to add before or after care for your child.

 

CIT Tuition - by invitation only

Members: ($200) July 20-24 and 27-31Non-members: ($255) July 20-24 and 27-31Members: ($125) July 20-24 (1 week)Non-Member: ($200) July 20-24 (Week #1 only)Member: ($110) July 27-31 (week #2 only)Non-Member ($200) July 27-31 (Week #2 only)CIT Program is for campers who are accepted into the counselor in training program.

Donation (optional)

Thank you for kind donation for children in our summer camp program.

Total Payment

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LIST TWO CONTACTS IN CASE OF AN EMERGENCY

* Contact Number 1 Name

* Contact Number 1 Phone Number

Contact Number 2 Name

Contact Number 2 Phone Number

Please list all allergies

Current Medications

Are there any disabilities or problems of which we should be aware?

* Child's Physician Name

Child's Physician Phone Number

* Insurance Company Name

* Insurance Company Policy #

PHOTOCOPY OF HEALTH INSURANCE CARD NEEDED

* I hereby give permission for my child (fill in name)

to participate in the programs at Congregation Rodeph Sholom including off campus trips.  In the event of an emergency, surgical or otherwise, and I cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility and specifically authorize the representative of Congregation Rodeph Sholom to select a physician and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which he/she feels are in the best interest of my child.  Congregation Rodeph Sholom is hereby released and held harmless from any claim, judgment, awards, settlements, or damages to any person or property arising directly or indirectly out of my child's participation in the programs at Rodeph Sholom, including off campus trips or the Congregation's selection of physician, hospital, or any other medical service for my child in a medical emergency, or in connection with the rendering of any such medical treatment.

* Parent 1/Guardian Signature

* Date

Parent 2/Guardian Signature (N/A if not applicable)

Date

Email

Password

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