Day Camp Registration Form

Camp B'Simcha Registration Form
Camp Pricing

Weekly Pricing: $300 early bird per week (325 weekly - non early bird) 1500 for the summer Camp B’simcha scholarship applications coming soon.
LOCK IN YOUR SPOT!

Please scan the QR code above to Zelle your 300$ non refundable deposit to secure your spot! This will lock you into the early bird special! DUE by January 26th
Camper's Information
Member ID
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Age
Age
Entering Grade in 2025/26*
Please Choose the weeks of Camp you are registering your child for?*
T-Shirt Size
First Day at Camp

MonthDayYear
Camper Swimming Ability*

Non-SwimmerBeginner SwimmerAdvanced Swimmer (can pass swim test)
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone*
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of camp,and able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*
Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*

Statement of Understanding
Camp B' Simcha has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info

Camp B'Simcha Registration Form