Early Learning Center Summer Program

* Household Name

Temple Shaari Emeth Member?

YesNo

* Household Phone Number

* Household Mailing Address

* City

* State

* Zip Code

Additional Household Mailing Address (if applicable)

Adult 1 Contact Information

First Name

Last Name

Cell Phone

Adult 2 Contact Information

First Name

Last Name

Cell Phone

Emergency Contact Information

First Name

Last Name

Relationship

Best #

* Number of Campers:

A non-refundable deposit of $100 per camper is required to secure your registration. This deposit will be put toward your final camp tuition. To discuss financial assistance, please contact the camp office at 732-462-3264.

Camper Information

Camper 1 First Name

Camper 1 Last Name

Date of Birth

Current Age

Please select enrollment here if attending Session 1 Only

Please Choose OneHalf-day M W F ($575) - $100.00Half-day M thru F ($1,025) - $100.00Full-day M W F ($950) - $100.00Full-day M thru F ($1,700) - $100.00

Please select enrollment here if attending Sessions 1 and 2

Please Choose OneHalf-day M W F ($925) - $100.00Half-day M thru F ($1,500) - $100.00Full-day M W F ($1,200) - $100.00Full-day M thru F ($1,900) - $100.00

Food Restrictions/Allergies

Any Special Needs/Friend Requests?

Camper 2 First Name

Camper 2 Last Name

Date of Birth

Current Age

Please select enrollment here if attending Session 1 Only

Please Choose OneHalf-day M W F ($575) - $100.00Half-day M thru F ($1,025) - $100.00Full-day M W F ($950) - $100.00Full-day M thru F ($1,700) - $100.00

Please select enrollment here if attending Sessions 1 and 2

Please Choose OneHalf-day M W F ($925) - $100.00Half-day M thru F ($1,500) - $100.00Full-day M W F ($1,200) - $100.00Full-day M thru F ($1,900) - $100.00

Food Restrictions/Allergies

Any Special Needs/Friend Requests?

Children will be released to their parents only. If someone other than a parent will be picking them up, a note signed by the parent must be brought to the director’s office during the course of the day.

No refunds will be given unless the child is out for an extended time due to a serious illness. Documentation must be signed by a doctor advising us of the illness.

Pictures may be taken for Temple promotional use.

* I/We understand that by submitting this form that we agree to the above terms and conditions of this application.

I/We understand that by submitting this form that we agree to the above terms and conditions of this application.

Total Deposit Due