CRA 2023 Summer Program - 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?

Click here for the CRA 2023 - FAQ

Click here for info on the Tikkun Olam Program

Questions about camp? Email Kyla Gersten at kyla@bnaiamoona.com

Questions about financial assistance? Email Anita 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?

Camp Tuition and Rates

* Grade as of Fall 2023

Grades K-4 Camp Tuition rates (per week):
Member - $310 / Non - Member - $370

Week of June 19 (4 day week):
Member K-4 $250 / Non - Member K-4 $300

Grades 5 & 6 Camp Tuition rates (per week):
Member - $340 / Non - Member - $400

Week of June 19 (4 day week):
Member 5-6 $275 / Non-Member 5-6 $320

*Prices for incoming 5th & 6th graders include the weekly Tiyul (field trip) that the oldest camp group takes each week.*

Grades 7 & 8 Camp Tuition rates (per week):
Member - $215 / Non - Member - $275

Week of June 19 (4 day week):
Members 7-8 $175 / Non - Member 7-8 $220

Click here for info on the Tikkun Olam Program

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

Please choose all that apply.

Session 1:	Session 2:
Week 1: Mon. June 12 - June 16 Week 2: Tues. June 20 - June 23 Week 3: Mon. June 26 - June 30	Week 4: Mon. July 10 - July 14 Week 5: Mon. July 17 - July 21 Week 6: Mon. July 24- July 28 Week 7: Mon. July 31 - Aug 4

*Minimum 2 week consecutive registration for the whole summer required.
Please note there is no camp the week of July 4.

Additional Information

* T-shirt Size

* My camper would enjoy being in a group with:

We will try our very best to honor requests of having your camper with their friend in their camp group as well as not having specific campers in a group with them.

* My camper would benefit being separated from:

We will try our very best to honor requests of having your camper with their friend in their camp group as well as not having specific campers in a group with them.

* 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

What has been your child's experience with school so far this year (virtual, in person, etc)?

Please briefly explain in the box above.

* 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?

*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

Field Trips

Each group will potentially take up to 2 field trips throughout the summer. I understand that I will be informed by email prior to my camper leaving the campgrounds (with the exception of the daily excursion to the Elks Lodge for swimming)
With the exception of the 5th and 6th graders who will be taking a weekly field trip.

Please contact kyla@bnaiamoona.com with any questions or concerns about field trips

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 my child may not attend Ramot Amoona if they are not fully vaccinated . I understand I will have to provide a copy of my child’s vaccine record no later than June 1 in order for my child to attend camp.

I understand that my child may not attend Ramot Amoona if they are not fully vaccinated . I understand I will have to provide a copy of my child’s vaccine record no later than June 1 in order for my child to attend camp.

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.

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. This includes but is not limited to vomiting, diarrhea, headache, sore throat, fever above 100.0, chills, body aches, loss of taste, loss of smell, congestion or runny nose, shortness of breath, sore throat.

* Yes, I agree to the camp sick policy.

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

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 will receive a letter on or before March 15, 2023 with my full tuition.

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 1, 2023. If I do not pay the full tuition by June 1, 2023 and I do not have a payment plan in place 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 by April 15, 2023.Make 2 equal payments: April and June 2023.Make 3 equal payments: April, May, June 2023.

* 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.

If not date is choosen, your account will be billed on the 15th of the month.

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. Requests for additional weeks are made on a case by case basis and must be approved by the Camp Director no later than the Thursday prior to the requested week.

* Any additional charges or changes for pre / post care will be documented each week and the credit card or ACH on file will be charged on the following Monday.

Any additional charges or changes for pre / post care will be documented each week and the credit card or ACH on file will be charged on the following Monday.

* With signature(s) below, Credit Card or ACH authority is to remain in full force and effect until Congregation B’nai Amoona has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Congregation B’nai Amoona a reasonable opportunity to act. Charges are made on the 15th of each month unless other arrangements are made.

With signature(s) below, Credit Card or ACH authority is to remain in full force and effect until Congregation B’nai Amoona has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Congregation B’nai Amoona a reasonable opportunity to act. Charges are made on the 15th of each month unless other arrangements are made.

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