Camp Little Feet Application

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Camp Little Feet at Temple Beth Rishon 585 Russell Avenue Wyckoff, NJ 07481 201-891-4466 Application- Summer 2017
Child's Name: *
Child's Name:
Phone: *
Phone:
Child's Sex:
Child's D.O.B.: *
Child's D.O.B.:
Address: *
Address:
Parent 1 - Name: *
Parent 1 - Name:
Parent 1 - Cell:
Parent 1 - Cell:
Parent 1 - Business Phone:
Parent 1 - Business Phone:
Parent 2 - Name:
Parent 2 - Name:
Parent 2 - Cell Phone:
Parent 2 - Cell Phone:
Parent 2 - Business Phone:
Parent 2 - Business Phone:
Caregiver/Babysitter:
Caregiver/Babysitter:
Tel. No.:
Tel. No.:
IN CASE OF EMERGENCY, list two people who can be responsible for your child if parents or caregiver cannot be reached.
Name 1:
Name 1:
Name 1: Phone
Name 1: Phone
Name 2
Name 2
Name 2 - Phone
Name 2 - Phone
Name 2 - Relationship:
Name 2 - Relationship:
Terms of Enrollment:
1. The person who signs this contract is responsible for the total tuition and fees.
2. I understand there is no credit for illness, holidays, vacations, early withdrawals, or closings due to weather or emergencies.
3. I will abide by the placement, teacher assignment, and the rules and regulations of Camp Little Feet.
4. My child will be sent home in case of illness and I will abide by Camp Little Feet’s policies.
5. A $300 non-refundable deposit is due at time of application.
Credit card information (required of all families regardless of method of payment.) Any accounts past due will be charged to credit card. NOTE: There is a 3% fee on all credit card payments.
Type:
Expiration Date:
Expiration Date:
* By checking this box and typing my name below, I am electronically signing this form. *
Date 1
Date 1
* By checking this box and typing my name below, I am electronically signing this form.
Date 2
Date 2