2023 Camp Shelanu Registration Form

CONTACT INFORMATION:

* Number of parents/guardians on account

Please Select OneOneTwo

Parent 1

* First Name

* Last Name

* Email

* Cell Phone

Home Phone

* Address

* City

* Zip Code

Parent 2

First Name

Last Name

Cell Phone

Home Phone

Does parent 2 live at the same address as parent 1?

Please Select OneYesNo

Parent 2 Address

Parent 2 City

Parent 2 Zip Code

PLEASE READ:

* I declare under penalty of perjury under the laws of the state of California that to the best of my knowledge, information and belief my camper is in good physical health and is capable of participating in camp activities, including swimming/water play, field trip experiences, and other vigorous physical activity.

I declare under penalty of perjury under the laws of the state of California that to the best of my knowledge, information and belief my camper is in good physical health and is capable of participating in camp activities, including swimming/water play, field trip experiences, and other vigorous physical activity.

MEMBERSHIP STATUS:

* Are you a current member of Congregation B'nai Israel?

CAMPER INFORMATION:

* How many children are registering for Camp Shelanu?

Camper 1 Information:

* First Name

* Last Name

Birthdate

Preferred Pronouns

Please let us know what your child prefers:
She/Her
He/Him
They/Them
Prefer not to say
Type your own

* Grade Entering in Fall 2023

* Shirt Size

* Will this be Camper 1's first time at Camp Shelanu?

Please Select OneYesNo

* All campers must be fully vaccinated. Upload an image of the CDC card or QR code to confirm vaccination status:

Medical and Allergy Information:

If Camper 1 takes any medication, please list each medication and what it's treating below:

Write N/A if not applicable

If Camper 1 has any allergies or food restrictions, please describe them below:

Write N/A if not applicable

Additional Information About Camper 1:

My child loves:

My child does not like:

What makes your child angry?

How does your child cope? What methods work best?

Is there anything else we should know about your camper that would enhance their Camp Shelanu experience?

Camper 2 Information:

* First Name

* Last Name

Birthdate

Preferred Pronouns

Please let us know what your child prefers:
She/Her
He/Him
They/Them
Prefer not to say
Type your own...

* Grade Entering in Fall 2023

* Shirt Size

* Will this be Camper 2's first time at Camp Shelanu?

Please Select OneYesNo

* All campers must be fully vaccinated. Upload an image of the CDC card or QR code to confirm vaccination status:

Medical and Allergy Information:

* If Camper 2 takes any medication, please list each medication and what it's treating below:

Write N/A if not applicable

If Camper 2 has any allergies or food restrictions, please describe them below:

Write N/A if not applicable

Additional Information About Camper 2:

My child loves:

My child does not like:

What makes your child angry?

How does your child cope? What methods work best?

Is there anything else we should know about your camper that would enhance their Camp Shelanu experience?

Camper 3 Information:

* First Name

* Last Name

Birthdate

Preferred Prounouns

Please let us know what your child prefers:
She/Her
He/Him
They/Them
Prefer not to say
Type your own...

* Grade Entering in Fall 2023

* Shirt Size

* Will this be Camper 3's first time at Camp Shelanu?

Please Select OneYesNo

* All campers must be fully vaccinated. Upload an image of the CDC card or QR code to confirm vaccination status:

Medical and Allergy Information:

* If Camper 3 takes any medication, please list each medication and what it's treating below:

Write N/A if not applicable

If Camper 3 has any allergies or food restrictions, please describe them below:

Write N/A if not applicable

Additional Information About Camper 3:

My child loves:

My child does not like:

What makes your child angry?

How does your child cope? What methods work best?

Is there anything else we should know about your camper that would enhance their Camp Shelanu experience?

CAMP TUITION:

Kindergarten – 5th grade

Camp tuition for K-5 campers is $295 for members and $325 for non-members per session.

Session #1 July 5 - July 7 is prorated to $225 for members and $285 for non-members.

All campers registered for 3 or more sessions, will receive a $20 discount off the 3rd, 4th and 5th sessions. The discount will be applied after registration.

9th – 10th grade (CIT's)

The CIT program costs $80 for members and $110 for non-members for the first session. Each additional session is $50 for members and non-members.

Camp tuition must be paid in full prior to the first day of the first session your camper(s) attend.

EMERGENCY CONTACTS:

Emergency Contacts: The following people have permission to pick up my camper from camp on a regular basis or in case of an emergency when one or both parent/guardians are unreachable.

* Emergency Contact - 1

Relationship to camper

* Phone Number

* Emergency Contact - 2

Relationship to camper

* Phone Number

Additional Camp Shirts

Would you like to purchase any additional shirts for your family? Additional shirts are $10 each.

Please Select OneYesNo

Please select the amount and sizes below.

Child Small

Child Medium

Child Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Before/After Care

Camp Shelanu offers childcare in the mornings and evenings surrounding normal camp hours. Before-Care is available from 7:30 – 9:00 AM, and After-Care is available from 4:00 – 6:00 PM. We need a minimum number of campers registered in advance in order to offer this care.

The weekly pricing is only offered if you sign up for childcare before July 1st. After that, all childcare will be considered drop-in.

Pricing:
Before-Care is available for $35 per week or $12 per drop-in day
After-Care is available for $50 per week, or $15 per drop-in day

Would you like to sign your child(ren) up for before/after care?

Please select how many children you would like to register for before-care each session?

Session 1

Session 2

Session 3

Session 4

Session 5

Please select how many children you would like to register for after-care each session?

Session 1

Session 2

Session 3

Session 4

Session 5

THE FINE PRINT!

* I acknowledge the following:

I acknowledge the following:I approve of the above registration for my camper. I understand that the Director of Camp Shelanu will contact me (or another emergency contact if I cannot be reached) in case of emergency. I hereby grant permission for my camper to be treated by qualified medical authorities as necessary and I give permission to the Director to hospitalize, secure proper treatment, order injections, anesthesia or surgery for my camper. I agree that we, our heirs, next of kin, guardians, successors and assigns or any other representative of ours will not sue, claim against, attach the property of or prosecute Camp Shelanu, Congregation B’nai Israel or any of its directors, officers, agents, and employees, and all affiliated entities for loss of property, injury, harm, accident, illness, loss of limb or life, or other personal injury, incapacity, medical cost, expense, damage, claim, liability, howsoever, caused, and regardless of whether caused directly or indirectly, by their acts or any other acts, arising out of or in connections with the camper’s participation in Camp Shelanu activities associated with CBI. The undersigned parent/guardian fully understands that s/he is responsible to pay all costs incurred as a result of the foregoing.

* I acknowledge the following:

I acknowledge the following:I hereby grant permission for my camper to attend Camp Shelanu field trips, with the full understanding thatthe transportation will be provided by van, bus and/or private car and, further Camp Shelanu staff and parents will supervise those field trips. I also understand that I have an option of attending the Field Trip and the right to transport my own camper. With this understanding, I freely grant permission for my camper to attend and in consideration for these camp services provided by Camp Shelanu and CBI hereby waive any and all claims, demands, damages for property damage, personal injury, or otherwise that might result from this activity and any and all actions that might otherwise exist against Camp Shelanu and CBI or any of its agents whether due to the active or passive negligence of the Camp or CBI and its staff or arising out of any other wrongful conduct other than intentional acts. This waiver and release is given freely and binding with my full knowledge thereof.

* Signature of Parent/Guardian

* Date

* Photo/Video Release - I acknowledge that Camp Shelanu is responsible for producing and publishing a variety of newsletters, brochures, videos and fliers. I hereby authorize Camp Shelanu and CBI to use, reproduce or publish photographs or videos of my camper or of me which may be taken during our participation in Camp Shelanu activities for any purposes without compensation to me or my camper.

I do not agree to the photo/video releaseI agree to the photo/video release

For other payment options, contact our Bookkeeper at bookkeeper@bnais.com or 916-446-4861
For general camp questions, contact Rabbi Stacy at rabbistacy@bnais.com.

Refund Policy:
- Refund requests must be made in writing and submitted to the Camp Director by June 30
- New enrollments or sessions added after July 1 are non-refundable
- Tuition will not be refunded for missed days of camp

Total Camp Fees

CONGREGATION B'NAI ISRAEL

Keeping Tradition, Moving Forward