REGISTRATION SUMMER 2021

CAMP DATES: JUNE 28 - AUGUST 18

Promotion deadline November 15th: Register by November 15th and Pay in full by December 31st. 

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)
  TRANS NURSERY - AGE 3 BY JAN. 15TH 2022 9:00AM - 3:00PM (Dismissal 2:45PM)
(Friday Dismissal 1:45PM)
 

NURSERY - AGE 3 BY OCT. 15TH 2021

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:
Full Session (June 28 - August 18)
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 6
Week 7 - August 9 - August 13
Week 8 - August 16 - August 18 8
 
     
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. PAYMENT IN FULL IS DUE BY DECEMBER 31ST. 

CAMP TUITION & SECURITY RATES:
   
 
SECURITY FEE   
WEEKLY RATE $10 / FULL SUMMER $80
 
TUITION 
TODDLER:  $1,995 FULL SUMMER / WEEKLY RATE $300 per week - No Discounts Available
TRANS NURSERY through 1st GRADE:  $2,495 Full Summer - *$2,245 until November 15th,
    WEEKLY RATE $375  - *$337.50 per week until November 15th
OLDER DIVISION: $2,595 FULL SUMMER, *$2,345 until November 15th
    WEEKLY RATE $400 *$360.00 per week until November 15th
 
*DISCOUNT ABOVE APPLIES WHEN REGISTERING FOR FOUR OR MORE WEEKS
 
AS WE GET CLOSER TO THE SUMMER WE WILL EVALUATE IF THERE WILL BE EARLY CARE AND  EXTENDED CARE FOR SUMMER 2021 
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)