Camp B'nai Ami 2019 - Form

Camp B'nai Ami 2019 Pricing

Click here for a downloadable PDF

We're very excited that you and your family want to be a part of Camp B'nai Ami, If you have questions about the the camp, please contact our Director Anita at anita@bnaiamoona.com or call us at 314-576-3688.

Please complete the registration form below. We recommend using Google Chrome when using the form.

***New This Year***

As part of our ongoing quest to make registration as easy as possible, some of the fields below display the current information we have on file for you and your child. Any changes you make to these fields will be updated in our system.

Please make sure you are logged in in order to use this update.

As always, if you have trouble filling out the form, please contact our webmaster Tanya at 314-576-9990 x323 or email her at tanya@bnaiamoona.com

Family Information

Child's Information

* Child's First Name

* Child's Last Name

Child's Nickname

Child's Hebrew Name

ie Sarah Bat Rivkah v' David

* Child's Birthday

* Child's Gender

Parent 1's Information

* Parent 1's First Name

* Parent 1's Last Name

* Parent 1's Cell Phone

* Parent 1's Email

* Parent 1's Work Phone

Parent 1's Home Phone

Parent 2's Information

Parent 2's First Name

Parent 2's Last Name

Parent 2's Cell Phone

Parent 2's Email

Parent 2's Work Phone

Parent 2's Home Phone

If different from Parent 1.

* Address

* City

* State

* Zip

Address 2

If different from Address 1

City

State

Zip

* Are you a B'nai Amoona Member?

Synagogue Affliation

Camp Schedule

* How old will your child be as of June 1, 2019?

* Please choose which days you need care:

Please Select OneI need care Monday - Friday (at the same time)I need care on different days / times

Additional information

T-Shirt Size

* Does your child have any food allergies?

Please List:

Please review and update as needed. Any changes made will be applied to your account.

* Does your child have any non-food allergies?

Please List:

Please review and update as needed. Any changes made will be applied to your account.

* Does your child currently take any medications?

Please List:

Please review and update as needed. Any changes made will be applied to your account.

* Will your child be taking medication during school?

Please list Med / Dose / Time

ie Medicine - 2.5 ml - 1x at 12 pm

Please review and update as needed. Any changes made will be applied to your account.

I understand that if I do not have an account with B'nai Amoona, the information I have provided will be used to create one and I may be contacted for more information.

* Yes, I agree to a B'nai Amoona Account.

Yes, I agree to a B'nai Amoona Account._______________________________________

I understand that in accepting my enrollment, the Linda Rotskoff Early Childhood Center / Camp B'nai Ami reserves a place for my child for the program. Please note the Linda Rotskoff ECC reserves the right to cancel classes if minimum enrollment is not met. In order to qualify for member tuition, I must be a member in good standing at B’nai Amoona.

* Yes, I understand I am reserving a spot.

Yes, I understand I am reserving a spot._______________________________________

I am aware that vacation times and school closures have been prorated into these fees.

* Yes, I am aware of the prorated fees.

Yes, I am aware of the prorated fees.________________________________________

I understand that the Health/safety and school information packet will be sent home in June or July (or prior to your child's first day) and must be completed before the school year (or prior to when your child) starts.

* Yes, I agree to complete the health packet.

Yes, I agree to complete the health packet._______________________________________

When my child is ill, I understand and agree that s/he may not be accepted for care or remain in care.

* Yes, I agree to the sick policy.

Yes, I agree to the sick policy._______________________________________

I have been notified that I may request notice at initial enrollment or any time there after whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.

* Yes, I agree to the immunization policy.

Yes, I agree to the immunization policy._______________________________________

* I authorize B'nai Amoona Early Childhood (both Camp B'nai Ami and the ECC) to use still, slide, or video photographs of my child for its public relations.

I am aware that the LRECC does offer flexible add-on times for those who are not enrolled in full day programs. I can choose early morning drop off (7:30-8:50), late stay (3:30-6:00), lunch bunch (12:00-1:00) and extended day (1:00-3:30). Any additional charges will be added to your monthly statement.

* Yes, I am aware there may be additional charges.

Yes, I am aware there may be additional charges._______________________________________

I agree to pay the $200 registration fee. I understand that after I submit my registration and pay the non-refundable registration fee, I will receive an email from Linda Rotskoff Early Childhood Center at B'nai Amoona with the cost of my child's full tuition. I will be billed monthly on the 5th of each month and will be due by the 10th of each month. Additional charges accrued during the previous month (such as late pick up or early drop off) will be applied to the current months bill (ie late days for January will appear on February's bill).

* Yes, I will pay the $200 registration fee.

Yes, I will pay the $200 registration fee._______________________________________

Total Registration Fee