summer mini camp summer mini camp summer mini camp summer

Adolph & Rose Levis Jewish Community Center
SUMMER MINI
CAMP
Powered by
Summer Break is super fun at the Levis JCC! The Levis JCC is pleased to offer a
non-school mini camp program powered by YES. Children entering K – 5th grade
will enjoy a creative, fun-filled and active curriculum featuring recreational sports
(including Gaga, kickball, basketball, soccer and games), craft projects and much more!
May 26 - June 5
9:00 a.m. - 4:00 p.m.
$50 per day / $175 per week (May 26-29)
$225 per week (June 1-5)
Campers bring their own Kosher,
nut-free lunches; Kosher snacks
will be provided
Pre-care: 7:30-9:00 a.m., $5 per day
After care: 4:00-6:00 p.m., $6 per day
Both Pre- and After-Care: $10 per day
For more information contact
[email protected] or to register,
contact Jordyn Gechter at
(561) 852-3262
Adolph & Rose Levis Jewish Community Center • 9801 Donna Klein Blvd.
Boca Raton, FL 33428 • (561) 852-3200 • www.levisjcc.org
Adolph & Rose Levis Jewish Community Center • 9801 Donna Klein Boulevard • Boca Raton
SUMMER MINI CAMP AT THE J
ENROLLMENT FORM 2015
CHILD INFORMATION
Child #1 Name:
DOB:
School:
Grade:
q M q F
Allergies:
Summer Break (Entering K-5):
Dates
Child #2 Name:
DOB:
School:
qM qF
Grade:Allergies:
Summer Break (Entering K-5):
Dates
Pre Care
After Care
9:00am4:00pm (7:30-9:00am) (4:00-6:00pm)
May 26
May 27
May 28
May 29
q
q
q
q
q
q
q
q
q q q q
Pre Care
After Care
9:00am4:00pm (7:30-9:00am) (4:00-6:00pm)
June 1
June 2
June 3
June 4
June 5
q
q
q
q
q
q
q
q
q
q
q q q q
q
CHILDREN MUST BRING THEIR OWN KOSHER NUT-FREE LUNCH DAILY. KOSHER SNACKS WILL BE PROVIDED.
PARENT INFORMATION
Parent/GuardianLast Name:
Parent/Guardian First Name:
Other Parent/Guardian Name:
Levis JCC Member: q Yes q No
Address:
Home Ph:
City:Zip:
Cell:
Email:
EMERGENCY CONTACTS
Name:
Phone:Relationship:
Name:
Phone:Relationship:
ADDITIONAL PERSONS AUTHORIZED TO PICK UP CHILD(REN)
Name:
Phone:Relationship:
Name:
Phone:Relationship:
MEDICAL CARE
Family Physician Name:
Phone:
Health Insurance Company:
Policy #:
Adolph & Rose Levis Jewish Community Center • 9801 Donna Klein Boulevard • Boca Raton
SUMMER MINI CAMP AT THE J
ENROLLMENT FORM 2015
FEES
• $50/day, $175/week (May 26-29), $225/week (June 1-5);
Pre-Care: $5/day: After-Care: $6/day; Both Pre-and After-Care: $10/day
PAYMENT
Please enroll my child(ren) for the checked camp days/times on the previous page.
Payment Amount $
q MC
q Visa
q AmEx
Check #
q Discover
Please make check payable to the Levis JCC.
Card #
Exp. Date
TERMS
The undersigned acknowledges that (s)he is the parent or legal guardian of the child(ren) and authorizes the
Adolph & Rose Levis Jewish Community Center (Levis JCC) to act for the parents while the child(ren) are in
their care. This includes the power to authorize emergency treatment when it is deemed necessary and in the
best interest of the child(ren).
Participation in any of the Levis JCC activities and use of any recreational facilities involves risk of accidental
injury despite all safety precautions. Having been informed of the activities to be conducted by the Levis
JCC, the undersigned assumes all risks incidental to the activities and releases from liability and agrees to
indemnify and hold harmless the Levis JCC, its officers, directors, independent contractors, volunteers and
employees for any illness or injury to the undersigned, children of the undersigned and/or family members
occurring during his/her/their participation in any activity or use of any facility at/or conducted by the
Levis JCC.
Levis JCC may use photos, statements, articles, names, music, art, film, video tapes of or made by the
child(ren) in promoting the Levis JCC or its programming.
Parent/Legal Guardian Signature
Print Name
Date
For additional information, please contact Jordyn Gechter
at the Levis JCC Sports & Wellness building, (561) 852-3262.
Schedule subject to change. A minimum number of students must be enrolled to operate the program. We reserve the right to
cancel the program, in which case a full refund will be made. No refunds or credits will be made due to absences.