Virtual Camp SHM Summer 2020 for Non-Members

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* Parent #1 First Name

* Parent #1 Last Name

* Parent #1 Cell Phone Number

* Parent #1 Email Address

Parent #2 First Name

Parent #2 Last Name

Parent #2 Cell Phone Number

Parent #2 Email Address

* Home Address

* City

* State

* Zip

* Student #1 First Name

* Student #1 Last Name

* Camper #1 Gender: Please Select

Please Select OneMaleFemaleNon-Conforming

* Camper #1 Date of Birth

* Camper #1 Incoming Grade for Fall 2020

SHM Non-Members: Camp SHM is offering flexible dates, so families can sign up for Weeks #1-4 (June 16-July 7), Weeks #5-8 (July 14-August 4), for all eight weeks or specific weeks(s) individually. If you decide to register with the drop-in rate, you must register by the Thursday before that week’s class, so we can prepare your materials for the activities.

All Classes are Tuesdays 3:00-4:30pm on Zoom and are perfect for 2nd-7th graders. Siblings are more than welcome to join in and if you want to have an older/younger child attend, please feel free to register him/her or contact Rachel Bickford, rachel@shmtemple.org. Please know that the materials will be for the child(ren) registered.

PLEASE CHOOSE YOUR OPTIONS BELOW.

Virtual Summer Camp Session(s) your Camper will be joining:

$250 for Weeks #1-8: Tuesdays 6/16-8/4 (save $30!)$125 for Weeks #1-4: Tuesdays 6/16-7/7 (save $15!)$125 for Weeks #5-8: Tuesdays 7/14-8/4 (save $15!)Flash Sale Prices were available only Thursday, 6/11/20.

June 16th: Art and HebrewJune 23rd: Cooking and HebrewJune 30th: Song Session, Art and HebrewJuly 7th: Creativity and HebrewJuly 14th: Calligraphy and HebrewJuly 21st: Art and HebrewJuly 28th: Creative Writing and HebrewAugust 4th: Science and HebrewFor a detailed description of each activity, please see the flyers above.

* Does Camper 1 have any learning, medical or emotional challenges that may affect him/her at Camp? Please select.

Please Select OneYesNo

Please explain:

* Does Camper 1 currently have an I.E.P. or 504 Plan in his/her educational setting? Please select

Please Select OneYesNo

What kinds of accommodations or modifications is he/she currently receiving?

Please list any allergies Camper 1 may have:

Please list any other special circumstances of which the Camp/counselor should be aware:

Please list any medications Camper 1 is on:

Do you need to enroll any more students?

NoYes, 1 additional studentYes 2 additional students

Camper #2 First Name

Camper #2 Last Name

Student #2 Gender: Please select

MaleFemaleNon-Conforming

Camper #2 Date of Birth

Camper #2 Incoming Grade for Fall 2020

Virtual Summer Camp Session(s) your Camper will be joining:

Does Camper 2 have any learning, medical or emotional challenges that may affect him/her at Camp? Please select

YesNo

Please explain:

Does Camper 2 currently have an I.E.P. or 504 Plan in his/her educational setting? Please select

YesNo

What kinds of accommodations or modifications is he/she currently receiving?

Please list any allergies Camper 2 may have:

Please list any other special circumstances of which the Camp/counselor should be aware:

Please list any medications Camper 2 is on:

Camper #3 First Name

Camper #3 Last Name

Camper #3 Gender: Please select

MaleFemaleNon-Conforming

Camper #3 Date of Birth

Camper #3 Incoming Grade for Fall 2020

Virtual Summer Camp Session(s) your Camper will be joining:

Does Camper 3 have any learning, medical or emotional challenges that may affect him/her in Camp? Please select

YesNo

Please explain:

Does Child 3 currently have an I.E.P. or 504 Plan in his/her educational setting? Please select

YesNo

What kinds of accommodations or modifications is he/she currently receiving?

Please list any allergies Camper 3 may have:

Please list any other special circumstances of which the Camp/counselor should be aware:

Please list any medications Camper 3 is on:

For weekly camp materials, you can pick them up at Heather Rosenthal's house in Tustin or Rachel Bickford's house in Ladera Ranch. If you prefer to have them dropped off to your home for all classes you are signed up for, there is an additional cost of $18 per session. To add Materials Drop Off to your registration, please indicate below.

Liability Release

I hereby grant permission for my child to participate in all Temple youth programs, activities and events and do release Congregation Shir Ha-Ma’alot and its representatives from all liability arising out of my child’s participation in such activity.

By selecting Yes below and by enrolling your child(ren) in Camp SHM at Congregation Shir Ha-Ma'alot, you indicate your agreement to the above terms and conditions.

* Liability Release

Liability Release

Yes, I have read and agree to these terms and conditions.

Total

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