subject_line
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
*
Female
Male
Name of Current School
*
Grade entering in Fall 2021
*
Toddlers - must be 2 by December 1, 2021
Nursery 3 - must be 3 by December 1, 2021
Nursery 4 - must be 4 by December 1, 2021
Kindergarten - must be 5 by December 1, 2021
1st - must be 6 by December 1, 2021
2nd - must be 7 by December 1, 2021
3rd - or 4th grade ( we will make this group if we have a minimum of 8 campers)
-
Please select one of the following sessions for your child:
For Campers entering Toddlers
Session 1 - Mon. - Fri. 9 am - 12:30 pm
Session 2 - Mon. - Fri. 9 am - 12:30 pm
Full summer - Mon. - Fri. 9 am - 12:30 pm
-
For Campers entering Nursery 3
Session 1: 9 am - 1 pm - Monday - Friday
Session 1: 9 am - 3:30 pm - M-Th & Friday 9-2pm
Session 2: 9 am - 1 pm - Monday - Friday
Session 2: 9 - 3:30 pm M-Th & Friday 9 -2 pm
Full Summer: 9 am - 1 pm -Monday - Friday
Full Summer: 9 am - 3:30 pm -M-Th & Friday 9-2pm
For Campers Entering Nursery 4, Kindergarten and 1st Grade:
Session 1: M-Th 9 -3:30 pm & Fri. 9 - 2 pm
Session 2: M - Th 9 -3:30 pm & Fri. 9- 2 pm
Full Summer: M - Th. 9 - 3:30 pm & Fri. 9 - 2 pm
For Campers entering Grades 2 and 3:
Session 1: M -Th 9 - 3:30 pm & Fri. 9 -2
Session 2: M - Th 9 - 3:30 & Fri. 9 - 2
Full Summer: M- Th 9 -3:30 & Fri 9-2
Household / Adult Primary Contact Information
First Name
*
Last Name
*
Relationship to Child
*
Mother
Father
Other
Address 1
*
Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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!
*
Non-refundable deposit($400.00)
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.
*
clear