Registration

FAMILY INFORMATION
Last Name

Address

City

State

Zip Code

Home Phone Number

Father's First Name

Father's Occupation

Father's Email Address

Father's Cell Phone Number

Father's Work Number

Mother's First Name

Mother's Occupation

Mother's Email Address

Mother's Cell Phone Number

Mother's Work Number

Would like to be a part of the texting system if you do not have whatsapp?

EMERGENCY CONTACT:
Name

Relation to camper

Cell Phone Number

DOCTOR INFORMATION
Doctor's Name

Doctor's Phone Number

CAMPER INFORMATION
Child's Name

Date of Birth

Yeshiva

Present Grade

Rebbi's Name

Rebbi's Phone Number

Trip Attendance

Full Season (June 28-August 17)

Session One (June 28- July 21)

Session Two (July 24 - August 17)

Six Week Session (July 10th-August 17)

Whole Summer Price List:
(Early Bird Special: take off $100)

Half Summer Price List:
(Early Bird Special: take off $50)

6 Week Summer Price List:
(Early Bird Special: take off $50)

T-Shirt Size

Lunch Prices

Bus

Bunk Request

Medical Comments- Limitations for camp activities (i.e. physical, visual, auditory, etc.)

Do you want to register an additional child?

Yes

No

Child's Name

Date of Birth

Yeshiva

Present Grade

Rebbi's Name

Rebbi's Phone Number

Trip Attendance

Full Season (June 28-August 17)

Session One (June 28- July 21)

Session Two (July 24 - August 17)

Six Week Session (July 10th-August 17)

Whole Summer Price List:
(Early Bird Special: take off $100)

Half Summer Price List:
(Early Bird Special: take off $50)

6 Week Summer Price List:
(Early Bird Special: take off $50)

T-Shirt Size

Lunch Prices

Bus

Bunk Request

Medical Comments- Limitations for camp activities (i.e. physical, visual, auditory, etc.)

Do you want to register an additional child?

Yes

No

Child's Name

Date of Birth

Yeshiva

Present Grade

Rebbi's Name

Rebbi's Phone Number

Trip Attendance

Full Season (June 28-August 17)

Session One (June 28- July 21)

Session Two (July 24 - August 17)

Six Week Session (July 10th-August 17)

Whole Summer Price List:
(Early Bird Special: take off $100)

Half Summer Price List:
(Early Bird Special: take off $50)

6 Week Summer Price List:
(Early Bird Special: take off $50)

T-Shirt Size

Lunch Prices

Bus

Bunk Request

Medical Comments- Limitations for camp activities (i.e. physical, visual, auditory, etc.)

Notes (Optional)

PAYMENT POLICY:
Payment in full can be made in the following methods: A deposit of $100 must be included at the time of registration. 50% of the balance will be due on 4/1/2023 and the remaining 50% will be due on 5/1/2023. Any other arrangements must be approved by the camp office.
Please check off which method you will be using:

Checks- mailed to 18 South Parker Drive, Monsey NY 10952.

Credit Cards- please visit campelyon.com and enter your CC information and submit $103 deposit per child attending Camp Elyon.

Zelle- you may send your payments to elyonalive@gmail.com. Please submit $100 deposit per child attending Camp Elyon.

SIGNATURE
Trip/Activity Authorization/Hold Harmless Agreement: By signing this application, I hereby authorize Camp Elyon to take my child(ren) on all off-campus trips, all off-site swimming approved by the Rockland County Health Department and participate in all activities. I will hold Camp Elyon harmless in the event of injury or property damage or loss as a result of such activities.
Medical Authorization: In the event of accident or illness, I authorize Camp Elyon to institute and obtain medical care for my child (ren).
Cancellation/ Refund Policy: Full camp fees must be paid by June 1, 2023. Camp fees are not refundable for late arrivals, cancellations, missed weeks, or early departures. Any total or partial cancellations until April 1st are refundable in full (minus $100 deposit). Any total or partial cancellations after April 1st up until June 1st will be subject to a 50% cancellation fee of your total charges minus your deposit. After June 1st there will be no refunds. If payment in full has not been made by June 1, 2023 (or arrangements have not been made with our office) we reserve the right to cancel your registration. All new campers are subject to acceptance. Please be in touch a week after your application has been sent in.

Clear

Parent Signature

Name

Date