REGISTRATION SUMMER 2021

CAMP DATES: JUNE 28 - AUGUST 18

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. 
Note: Please use a separate form for each child.

Camper/Parent Information                                                                                                                            
 
 
Name   

First
Middle
Last
Hebrew      
 
 
Address
  Street City
State
Zip
 
DOB
    Date of Birth (mm/dd/ccyy)     Gender                                            
                                               
 
 
Contact Info
  Home Phone
Mother Email
Father Email

 
 
Schools
  School
Hebrew School Entering Grade (9/21:
 
 
Child's Mother
  Mother's Name
Hebrew Name
Cell Phone
 
 
 
Child's Father
  Father's Name
Hebrew Name
Cell Phone
 
 
 
Pediatrician
  Name
Phone
   
  Please indicate which age group your child will be attending:
  TODDLER - AGES 2 BY OCT. 15TH 2021 9:00AM - 1:00PM (Dismissal 12:45PM)
  NURSERY - AGE 3 BY OCT. 15TH 2021 9:00AM - 3:00PM (Dismissal 2:45PM)
(Friday Dismissal 1:45PM)
 

TRANS NURSERY - AGE 3 BY JAN. 15TH 2022

9:00AM - 3:00PM (Dismissal 2:45PM)    
(Friday Dismissal 1:45PM)

  PRE-K - GRADE 1
(GRADE 1 - BOYS/GIRLS SEPARATED)
  9:00AM - 3:00PM (Dismissal 2:45PM)
(Fridays  Dismissal 1:45PM)
     
 

OLDER DIVISION
GRADE 2 - 6 (BOYS/GIRLS SEPARATED)

9:00AM - 3:15PM (Dismissal 3:00PM) 

(Fridays Dismissal 2:00PM)

  Please indicate when your child will be attending camp:
   
Week 1 - June 28 - July 2
Week 2 - July 6 - July 9 (No camp July 5)
Week 3 - July 12  - July 16
Week 4 - July 19 - July 23 
Week 5 - July 26 - July 31
Week 6 - August 2  - August 14
Week 7 - August 16 - August 18
 
     
Registration  

A NON REFUNDABLE $500 DEPOSIT MUST BE PAID AT THE TIME OF REGISTRATION AND TUITION PAID BY BY . THIS DEPOSIT WILL BE APPLIED TOWARDS THE TOTAL PRICE OF CAMP. 

CAMP TUITION & SECURITY RATES:
   
 
SECURITY FEE   
WEEKLY RATE $10
 
TUITION 
 
TODDLER: WEEKLY RATE $300 
NURSERY/TRANS NURSERY: WEEKLY RATE $375 
PRE-K THRU 1ST :WEEKLY RATE $375
OLDER DIVISION: WEEKLY RATE $400 
 
THERE WILL BE NO EARLY CARE/EXTENDED CARE DURING SUMMER 2021 
AS WE GET CLOSER TO SUMMER WE WILL HAVE A BETTER IDEA ABOUT EXTENDED CARE 
PAYMENT
Option:  

Check (for the deposit or full payment) payable to Lubavitch on the Palisades
Credit Card (A 3% charge will be added to credit card payments)

Name on Card  
Card Number  
Expiration    Date                                  
Security Code  
Total Amount  
Signature: Date of Application:

If the billing address for the credit card is different then the address above, please indicate the address in the comments below.
COMMENTS: (DO NOT INCLUDE FRIEND REQUESTS)