Camp Yedidos Registration

Camp Yedidos Registration Form

For girls entering Nursery - 6th grade.
Dates: June 22 - August 7
Location: JDBY - 3200 W Peterson Ave
Hours: Monday- Thursday: 9:30-3:30, Friday 9:30-1:15
Child's Name*

First NameLast Name
Birth date

MonthDayYear
Grade Completed *
Camp attendance:*

Attending full session: $1260Attending first session: $745
Afternoon clubs attendance:

Attending clubs full session: $180Attending clubs first session only: $100
Would you like to add another child?

YesNo
How many more children?

123
Child's Name 2*

First NameLast Name
Birth date

MonthDayYear
Grade Completed *
Camp attendance:*

Attending full session: $1260Attending first session: $745
Afternoon clubs attendance:

Attending clubs full session: $180Attending clubs first session only: $100
Child's Name 3*

First NameLast Name
Birth date

MonthDayYear
Grade Completed *
Camp attendance:*

Attending full session: $1260Attending first session: $745
Afternoon clubs attendance:

Attending clubs full session: $180Attending clubs first session only: $100
Child's Name 4*

First NameLast Name
Birth date

MonthDayYear
Grade Completed *
Camp attendance:*

Attending full session: $1260Attending first session: $745
Primary Email*
To receive camp newsletters
Afternoon clubs attendance:

Attending clubs full session: $180Attending clubs first session only: $100
Home Phone
Father's Name
Cell Phone
Mother's Name
Cell Phone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total
Emergency Contact

Please choose someone local. This may not be a parent
Name*

First NameLast Name
Home Phone
Cell Phone*
Relationship to child*
Health Information
Pediatrician’s Name*
Phone Number*
Please enter a valid phone number.
Medical Allergies / Other information
If you are registering more than 1 child, please specify child's name.
Release and Waiver of Liability

EMERGENCY MEDICAL AUTHORIZATION
By completing and signing this form I, for my child, myself, and anyone in my power expressly understand and agree that Camp Yedidos LLC, employees or volunteers are not liable for any injury or damage which may occur to my child(ren) in any conceivable or inconceivable way while she (they) are under their care, including any transportation to and from the camp or any activities. In case of an emergency or in the event of any illness or injury I give my consent and authorization to any of the staff members of Camp Yedidos to make any necessary medical decisions. I also hereby authorize Camp Yedidos to bring my child(ren) on any trips organized as part of the Camp Yedidos program. I have read the aforementioned liability waiver and agree to abide by all its conditions and terms as well as all camp regulations.
Child / Children's Name(s)*
Parent / Legal guardian's name*
Signature of Parent / Legal guardian*

Clear
Bunk Requests
Child's Name
Friend #1
Friend #2
Friend #3
Child's Name 2
Friend #1
Friend #2
Friend #3
Child's Name 3
Friend #1
Friend #2
Friend #3
Child's Name 4
Friend #1
Friend #2
Friend #3
Please tell us a bit about your child/children
Camp Payment

Payment is due in three installments - May 1, June 1, July 1. All payment must be completed by July 1, 2026.
Choose a payment method:*

Zelle - payment@campyedidoschicago.comCredit card (addt. 2% fee)Check - made out to Camp Yedidos LLC and sent to Mrs. Pam 6617 N. Francisco Ave
How many payments?

123
Terms

Please review the following:
• No monetary credit will be given for any days which a camper is absent.

• You should receive confirmation of your registration by the end of February.

• Tznius guidelines that apply throughout the year are in effect in camp as well. Socks must be worn by all campers, and knee-socks and long sleeves by campers coming out of first grade, and up. No electronic gadgets may be brought to camp.

• Camp Yedidos does its best to return all labeled items. Any items left in camp and not claimed by August 7 will be hefker.

By signing below, you are confirming that you accept these terms.
Parent / Legal guardian's name*
Date*

MonthDayYear
Date
Signature*

Clear
Registration Fee

$100 per child

Total due upon registration*

USD

Secure Credit Card Payment
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please note the following schedule changes:
Thursday, July 2, Shiva Asur B'tamuz, camp ends at 2:00 pm.
Wednesday July 22, Erev Tisha B'av, camp ends at 1:00 pm.
Thursday, July 23, Tisha B'av, there is no camp.

If you have any questions, please email: info@campyedidoschicago.com or call: Mrs. Pam 347.452.7834 or Mrs. Ehrman 718.705.8650
Reply to Email
Grade Completed
Grade Completed
Grade Completed
Grade Completed
Should be Empty:

Camp Yedidos Registration Form

Emergency Contact

Health Information

Release and Waiver of Liability

Bunk Requests

Camp Payment

Terms

Registration Fee