Camp Ruach Registration Form (2025)

Camp Ruach Registration Form

Summer 2025
Dear parents,

It's that time of the year again! Please complete this form to begin the Camp Ruach Early Childhood Camp registration process for summer 2025. Please note that registration is on a space-available basis, and that space is not guaranteed until we collect your payment information (if necessary), charge you the required $200 non-refundable deposit, and confirm your registration via e-mail.

No children will be admitted to begin school without providing all forms required by the JCC and DHS. These forms are available here or on the JCC website under Early Childhood - Parent Resources.

You must fill out ONE APPLICATION PER CHILD. If you have more than one child, please submit this application and then re-start a new one for each additional child.

For questions about the ECE program and registration, contact Jen Moyer, ECE Director, at jmoyer@lvjcc.org. Or, call us at 610-435-3571 or drop by any time!

We look forward to seeing you and your children for another fun summer!
Are you a current member of the JCC of the Lehigh Valley?*

YesNo
Which weeks will your child attend?*

Week 1 (6/16 - 6/20): Castaway AdventureWeek 2: (6/23 - 6/27): World TourWeek 3 (6/30 - 7/3): Creepy, Crawly Exploration* (No Camp 7/4 - JCC Closed)Week 4 (7/7 - 7/11): A Week at the MuseumWeek 5 (7/14 - 7/18): Superheroes and Fairy TalesWeek 6 (7/21 - 7/25): Camp Ruach GamesWeek 7 (7/28 - 8/1): Under the SeaWeek 8 (8/4 - 8/8): Outer Space AdventuresWeek 9 (8/11 - 8/15): Blowing off STEAMWeek 10 (8/18 - 8/20): Hollywood at the J* (3 Day Week)
Are you a new or returning ECE student?*

New StudentReturning Student
Anticipated Start Date

MonthDayYear
What day to you plan for your child to start school?
Child's Name*

First NameLast Name
Current Classroom*
Gender*

MaleFemale
Cutoff Date

MonthDayYear
Birthdate*

MonthDayYear
Age as of 9/1/25
This is calculated automatically based on the birthdate above.
Allergies/Special Needs*
If none, please enter "None" in the box.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Family Religion(s)

JewishCatholicMuslimProtestantHinduBuddhistSikhNoneOther
The JCC embraces families of all faiths. This information is used to help us better understand the population that we serve.
Synagogue Affiliation
Parent 1 Name*

First NameLast Name
Parent 1 Birthdate*

MonthDayYear
Date
Relation to Child*
Parent 1 Cell Phone*

Area CodePhone Number
Parent 1 E-mail*
Parent 1 Occupation*
Parent 1 Employer
If there are two parents, do they live together?*

Parents live togetherParents live apartOnly 1 parent
Parent 2 Name

First NameLast Name
Parent 2 Birthdate

MonthDayYear
Date
Relation to Child
Parent 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 2 Cell Phone

Area CodePhone Number
Parent 2 E-mail
Parent 2 Occupation
Parent 2 Employer
What is the relationship between the two parents?

Married/PartnersSeparated/Not MarriedWidowed
Program*

2 years by 9/1/253 years by 9/1/25
Program Hours*

Full Day - 3 days (Mon, Wed, Fri), 7:30am-5:30pmFull Day - 5 days (Mon-Fri), 7:30am-5:30pmHalf Day - 3 days (Mon, Wed, Fri), 8:30am-1:00pmHalf Day - 5 days (Mon-Fri), 8:30am-1:00pm
Families are encouraged to participate in our Family Appreciation Fund, which is used to provide holiday gifts, gift cards, meals and events in appreciation of our teachers. By checking this box, I understand my account will be charged $50 per child in September and $50 per child in February for this fund. Participation is optional.
Teacher Appreciation Fund

Yes, please include me in the Teacher Appreciation Fund!
Promotional Code
If given an Promotional Code, enter it here. Otherwise, leave this blank.
Today's Date

MonthDayYear
READ THE FOLLOWING BEFORE SIGNING:

Terms of Use

Membership Agreement

Payment & Refund Policy

Waiver, Release and Indemnification Agreement

Child Care Parent Agreement

Guest Pass Policy
By signing below, I acknowledge that I have read, understand and accept the Terms of Use, Membership Agreement, Payment & Refund Policy, Waiver, Release and Indemnification Agreement, Child Care Parent Agreement, and Guest Pass Policy.*
Are you applying for financial aid?

JCC Financial Aid/Flexible TuitionChild Care Works/ELRC ("Title XX")
Should be Empty: