Clone of M-Cats Summer Camp Registration Form 2025

Registration and Payment Form
Today's Date

MonthDayYear
Date
Early Bird Discount Date

MonthDayYear
Date
Additional Weekly Amount (after Early Bird)
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Entering in September*
Gender*

MaleFemale
T-Shirt Size*

Parent/Guardian Information
Parent/Guardian #1 Name*

First NameLast Name
Cell Phone*
E-mail Address*
example@example.com
Parent/Guardian #2 Name

First NameLast Name
Cell Phone
E-mail Address
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Registration Options
For ECC students (ECC2 through Kindergarten), weeks 1 and 3 are $500 and week 2 is $450.
For Elementary School students, weeks 1 and 3 are $520 and week 2 is $460.
Note: A $60 early bird discount per week will be applied, provided that payment is made by March 27, 2026.
Registering for:

ECC Week 1 (June 22–26)ECC Week 2 (June 29–July 2; no camp on July 3)ECC Week 3 (July 6–10)
ECC Week 1 Cost
ECC Week 2 Cost
ECC Week 3 Cost
ECC Total Cost
Registering for:

Elementary School Week 1 (June 22–26)Elementary School Week 2 (June 29–July 2; no camp on July 3)Elementary School Week 3 (July 6–10)
ES Week 1 Cost
ES Week 2 Cost
ES Week 3 Cost
ES Total Cost
Total Cost

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Maimonides School during M-Cats Summer Camp. I am aware that the playing, practicing, and participation in any activity can be dangerous, involving many risks including serious injury or death. I hereby assume all the risks associated with my child’s participation. I understand that the school does not provide medical or accident insurance for camp enrollees.

I hereby consent to permit all staff working at the camp to provide emergency first-aid or medical treatment for my child, according to their best judgment, in the event he/she suffers an injury or illness while participating in the camp or on the camp premises. In case of injury to said child, I hereby waive all claims against Maimonides School and their respective employees, agents, representatives, first responders and volunteers from any and all liability, actions, causes of actions, claims or demands for personal injury, death or property damage of any kind or nature, and any other claims whatsoever arising out of, or in any way connected with my child’s participating in M-Cats Summer Camp.

I hereby consent to the taking photographs or videos of my child for promotional purposes unless I have notice on file with the school restricting such use.

Maimonides School reserves the right, at the sole discretion of the Camp Director in consultation with the Head of School, to dismiss a child from camp whose conduct or influence is disruptive, uncooperative, etc. In these cases, there will be no refund of any part of the program fee.
Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

Clear
Name of Transaction
Payment Amount?

I would like to pay the full amount.I would like to pay the deposit only.
Maximum Amount to Pay (Deposit or Max)
Final Amount Calculation (Copies from Final Amount to Pay Now)
Payment Due Now

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Registration and Payment Form

Camper Information