Camp Bnai Ami 2020 Registration - Form

A few helpful tips:

1) We recommend using Google Chrome

2) To ensure the accuracy of your child's information, please log in prior to filling out the form

3) When logged in, 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.

Questions?

Questions about camp? Email Anita Kraus at Anita@bnaiamoona.com

Need help logging in or making a payment, contact our webmaster Tanya at 314-576-9990 x142 or email her at tanya@bnaiamoona.com

Family Information

Camper's Information

* Camper's First Name

* Camper's Last Name

* Camper's Birthday (MM/DD/YYYY):

* Camper's Gender

Guardian 1's Information

* Guardian 1's First Name

* Guardian 1's Last Name

* Guardian 1's Cell Phone

* Guardian 1's Email

* Guardian 1's Home Phone

* Guardian 1's Work Phone

Guardian 2's Information

Guardian 2's First Name

Guardian 2s Last Name

Guardian 2's Cell Phone

Guardian 2's Email

Guardian 2's Home Phone

If different from Guardian 1

Guardian 2's Work Phone

* Address

* City

* State

* Zip

Address 2

If different from Address 1

City

State

Zip

* Are you a B'nai Amoona Member?

Please list where you are a member:

Camp Tuition and Rates

* Age as of June 1, 2020

Please choose which weeks your camper will be attending camp, pre-care, and post care below.

Please choose all that apply.

Session 1
Week 1: Mon. June 8 - June 12
Week 2: Mon. June 15 - June 19
Week 3: Mon. June 22 - June 26

Session 2
Week 4: Mon. June 29 - July 2*
*No Camp July 3rd
Week 5: Mon. July 6 - Wed July 10
Week 6: Mon. July 13 - July 17

Session 3
Week 7: Mon. July 20 - July 24
Week 8: Mon. July 27 - July 31
Week 9: Mon. Aug 3 - Aug 7

Please choose which days you need care

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

Additional Information

* T-shirt Size

* How does your child feel about swimming?

Please Select OneComfortable in the waterUncomfortable in the water

Please Explain

* My child is mostly

Please Select OneReservedOutgoing

* How does your camper feel in loud environments?

Please Select OneComfortableUncomfortable

Please Explain

* Social / Emotional Concerns

* Additional Learning Challenges

* Does your student have an IEP (Individualized Education Plan ) or 504 plan?

Please Select OneNoYes*If “yes,” we will call to discuss this with you further.

Please email a copy of your child’s IEP or 504 plan to Liessa Alperin at Liessa@bnaiamoona.com and Kyla Gersten at kyla@bnaiamoona.com

This will be kept confidential, but be used to create the best learning plan for your students.

Waivers and Authorizations

B'nai Amoona Account

Yes, I agree to a B'nai Amoona 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.

Social Media

* Please choose your level of social media representation for your child

Please select oneVideo and photographic stills of my child are allowed to be used in advertising and social media outlets such as B'nai Amoona's website, bulletin, public Facebook page, the Jewish Light, etc blic Facebook page, the Jewish Light, etcVideo and photographic stills of my child are only allowed in a closed social media space such as a private B'nai Amoona Facebook groupNo video or photographic stills of my child are allowed on any form of social media or advertising for B'nai Amoona

Emergency Pick Ups

* Please check the appropriate box indicating who may pick up your child in the event of a disaster:

Please select oneMy child may only be picked up by his/her parent or guardian.My child may leave with anyone he/she feels comfortable riding with (relatives, neighbor, etc.)My child may be picked up by anyone he/she feels comfortable with except the following people:

Please list the people below who are NOT authorized to pick up your child

Health and Safety

Please review the information below and update as needed. Any changes made will be saved to your child's account for future reference.

Medical Forms

I understand that all health/safety information must be completed before camp (or prior to when your child) starts.

Yes, I agree to complete all medical forms.

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

Yes, I agree to the camp sick policy.

Allergies and Medications

* Food Allergies

* Non - Food Allergies

* Additional Medical Concerns

* Current Medications & Dosages

Medical Treatment

* Will your child be taking medication during camp?

Please Select OneNoYes

Please list Med / Dose / Time

ie Medicine - 2.5 ml - 1x at 12 pm

We will treat students with Band-Aids, antibiotic ointment (i.e. Neosporin), or ice packs in case of injury. We will NOT treat a child with oral medication without written or oral consent (via telephone) by a parent/legal guardian.

I agree to basic medical treatment

I give permission for Camp Bnai Ami staff to apply sunscreen to my child.

In an emergency, I request the Director or designee to contact the home or one of the relatives/friends listed. If unable to contact anyone, I hereby authorize Camp Ramot Amoona to make such arrangements as seem necessary, and I also authorize the hospital and physician to perform necessary procedures. I prefer my child to be taken to __________ Hospital or a nearby hospital if deemed necessary. Costs of the medical attention and ambulance are responsibility of parent/guardian. It is understood and agreed that Congregation B’nai Amoona, or its agents, servants, and employees shall not be liable for any claims, actions, or causes of action arising out of any conduct authorized here, and the undersigned hereby specifically releases the Congregation B’nai Amoona and its agents, servants, and employees from any and all such claims, actions, or causes of action.

Please indicate your preferred hospital below

I agree, in cases of extreme emergencies, my child will be brought by ambulance to the nearest hospital.

Payment Options

I hereby understand that I am paying a deposit of $200 and I will receive an email with my full tuition costs within a week.

If I do not pay in full, my bill will be split into monthly payments and my credit card on file will be charged during the first week of each month. I may also provide post dated checks. My full tuition will be due by June 7, 2020. If I do not pay the full tuition by June 7, 2020, my child's spot is not guaranteed.

* I understand I must pay in full for my child to attend camp.

I understand I must pay in full for my child to attend camp.

* Please choose your payment option for camp

Please Select OnePay in full after I receive my tuition confirmation email.Make 2 equal payments. One now and one in April 2020.Make equally monthly payments with the last payment being in May 2020.

* Please choose your payment method

Please Select OneACH (Electronic Check)Credit Card

Please choose the day of the month to charge your Credit Card / ACH.

Changes in Camp Weeks / Tuition

I hereby understand that any changes made to my registration including adding additional weeks and pre / post care, must be paid in full at the time of the change.

Yes, I am aware of the need to pay at the time that changes are made.

I would like to know more about camp scholarship opportunities

$200 Registration Fee STAFF WAIVER --- TO BE BILLED TO THE ACCOUNT

$200 Registration Fee STAFF WAIVER --- TO BE BILLED TO THE ACCOUNTI agree to pay the $200 registration fee in the agreed payment plan and I will receive an email with my full tuition costs explaining my payment options. I understand that I am requesting financial assistance and that I am obligated to pay the cost of camp that is not covered by the tuition assistance.

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