Camp Orot Summer 2021 Application

Important Dates:

Session 1: Monday, June 28 - Wednesday, July, 21

Session 2: Thursday, July 22 - Friday, August, 13

Full Session: Monday, June 28 - Friday, August, 13

Camper Applications

Camper Information

First Name *

Last Name *

Birthdate * +

Gender *

Name of Current School *

Grade entering in Fall 2021 *

Please select one of the following sessions for your child:

For Campers entering Toddlers

For Campers entering Nursery 3

For Campers Entering Nursery 4, Kindergarten and 1st Grade:

For Campers entering Grades 2 and 3:

Household / Adult Primary Contact Information

First Name *

Last Name *

Relationship to Child *

Mother

Father

Other

Address 1 *

Address 2

City *

State *

Zip *

Home Phone *

Cell phone *

Email Address *

Household / Adult Secondary Contact Information

First Name

Last Name

Relationship to Child

Mother

Father

Other

Address 1

Address 2

City

State

Zip

Home Phone

Cell phone

Email Address

Friend Request

Please list three (3) friends that you would like your child to be with in camp. You MUST list THREE names. We will do our best to place your child with at least one friend *

Emergency Contact Information

Does your child have any special medical needs? If yes, please explain: *

Does your child have any allergies? If yes, please explain: *

In the event of an emergency and you can't be reached, please provide the names and information of two people we may contact: First Contact *

Relationship to your child: *

Phone Number: *

Name of Second Contact: *

Relationship to your child: *

Phone Number: *

Agreements:

I/We give permission for our child(ren) to participate in trips sponsored by Camp Orot. I/We agree to hold Camp Orot and its employees harmless from any liability which may occur as a result of such trips including, but not limited to, transportation and participation in activities at the trip destination. *

Yes

No

Media Release, Photographer and Other Camper Material: It is the practice of Camp Orot to use photographs in its publications and in other selected media, including on the school/camp internet site for the purpose of promoting the camp and its programs. Camp Orot maintains the right to utilize such photographic and quoted materials or other selected media. I/We, as parent(s) and guardian(s), give permission to use photographic and quoted material in MDS or Camp Orot publications and other selected media. *

Yes

No

Cost of Camp

Toddler 1 Session - $1625
Toddler 2 Sessions - $2850
Nursery 3 1 Session - $1825
Nursery 3 2 Sessions - $3150
Nursery 4 - 3rd grade 1 Session - $1975
Nursery 4 - 3rd grade 2 Sessions - $3550
7 and 8 year olds 1 Session - $1975
7 and 8 year olds 2 Sessions - $3550

Non-refundable deposit ($400)- Due now! *

Camp Policy Regarding Early Withdrawal: If a child is withdrawn from camp before the end of the session by parents or guardians, no refunds will be given. *

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