Camp Cochavim Summer 2024 Registration - Form - Synagogue of the Suburban Torah Center (SSTC)

* Child's First Name

* Child's Last Name

* Child's Hebrew Name

* Date of Birth

* Language Spoken at Home

* Address Line 1

Address Line 2

* Address City

* Address State

* Address ZIP

* Custody Agreement

Enter "N/A" if not applicable.

* Bunk

Please select the Bunk that corresponds to the class your child will be going into in Fall 2024

* Please select session

Please Select One1st Half (June 24 - July 19)2nd Half (July 22 - August 16)Full 8 weeks (June 24 - August 16)

Are you interested in early or after care?

Early CareAfter CareNo ThanksPlease note our ability to provide early and after care will depend on demand and be subject to an extra fee.

First Parent or Guardian

* Child Lives With this Parent or Guardian

Please Select OneYesNo

Title

* First Name

* Last Name

* Relationship to Child

* Hebrew Name

* Home Phone

* Mobile Phone

* Email (will be used for confirmation)

* Employer

* Employer Address

How did you hear about Camp Cochavim?

Second Parent or Guardian

* Child Lives With this Parent or Guardian

Please Select OneYesNo

Title

* First Name

* Last Name

* Relationship to Child

* Hebrew Name

* Home Phone

* Mobile Phone

* Email

* Employer

* Employer Address

Social and Emotional Info

* Previous school experience

* Describe how the child handles separation

* Describe interactions

* Child's temperament

* Adjectives describing child

* Child's favorite activities

* Child's angers and fears

* To comfort child

Anything else we should know

Further Information

* Authorized person to pick up from camp

* Relationship to child

* Telephone

* Authorized person to pick up from camp

* Relationship to child

* Telephone

* Emergency contact name

* Relationship to child

* Emergency contact telephone

* Physician name

* Physician telephone

* Physician address

* Insurance carrier

* Policy Number

* Group Number

* Name of Policy Holder

* Allergies (if none please indicate)

* EpiPen

* Medical conditions

* I have read a copy of the Iris & Errol Berman Early Childhood Center’s Parent Handbook. I understand I am completely responsible for reading the Parent Handbook in its entirety before my child’s first day of attendance and should I have any questions or require clarification of any of the content, I am responsible for contacting the Iris & Errol Berman Early Childhood Center’s Director, Chaya Weisberg. I am aware that this Parent Handbook is not inclusive and is subject to change.

I have read a copy of the Iris & Errol Berman Early Childhood Center’s Parent Handbook. I understand I am completely responsible for reading the Parent Handbook in its entirety before my child’s first day of attendance and should I have any questions or require clarification of any of the content, I am responsible for contacting the Iris & Errol Berman Early Childhood Center’s Director, Chaya Weisberg. I am aware that this Parent Handbook is not inclusive and is subject to change. IEBECC Handbook can be viewed and downloaded HERE

* I am responsible for adhering to the policies and procedures as presented in the Parent Handbook.

I am responsible for adhering to the policies and procedures as presented in the Parent Handbook.

* I am aware that the Parent Handbook outlines the following: Discipline Policy, Expulsion Policy, Healthy Foods Policy, Communicable Disease Policy, Social Media Policy and Policy on the Release of Children.

I am aware that the Parent Handbook outlines the following: Discipline Policy, Expulsion Policy, Healthy Foods Policy, Communicable Disease Policy, Social Media Policy and Policy on the Release of Children.

* I have read and signed the Information to Parents document from the Department of Children and Families, Office of Licensing from the Iris & Errol Berman Early Childhood Center.

I have read and signed the Information to Parents document from the Department of Children and Families, Office of Licensing from the Iris & Errol Berman Early Childhood Center.

IEBECC NJ Licensing form can be completed HERE

* I have received and read a copy of the Expulsion Policy from the Iris & Errol Berman Early Childhood Center

I have received and read a copy of the Expulsion Policy from the Iris & Errol Berman Early Childhood Center

Download IEBECC's Expulsion Policy HERE

* I am aware that my child’s file, including medical information and emergency contact information, must be kept up-to-date at all times.

I am aware that my child’s file, including medical information and emergency contact information, must be kept up-to-date at all times.

* I authorize and release Iris & Errol Berman Early Childhood Center from the need to keep a record of my child’s drop-off and pick up during the school year.

I authorize and release Iris & Errol Berman Early Childhood Center from the need to keep a record of my child’s drop-off and pick up during the school year.

* I have read the carpool procedure for the Iris & Errol Berman Early Childhood Center and I agree to comply with all the items mentioned. I understand that failure to comply will result in serious action. In addition I am aware that it is New Jersey State law that all children of this age MUST be in a child safety seat. I am assuming personal responsibility if these guidelines are not met.

I have read the carpool procedure for the Iris & Errol Berman Early Childhood Center and I agree to comply with all the items mentioned. I understand that failure to comply will result in serious action. In addition I am aware that it is New Jersey State law that all children of this age MUST be in a child safety seat. I am assuming personal responsibility if these guidelines are not met.

* I permit my child to take staff-supervised walks.

I permit my child to take staff-supervised walks.

* Image Authorization

Please Select OneYesNoI understand that Iris & Errol Berman Early Childhood Center routinely takes photographs and videos of various activities, including classroom and learning activities, involving Iris Berman Early Childhood Center students, staff, parents and other attendees, which may include my child/children and me. By indicating YES above I give the Iris & Errol Berman Early Childhood Center the right, permission or authorization to use, or publish in whole or in part, photographs or videos taken of the minor child /children listed below, separately or in conjunction with other photographs or videos for use in Iris & Errol Berman Early Childhood Center's print, online or video based marketing materials, as well as other Iris & Errol Berman Early Childhood Center publications.

Registration Costs

Deposit: $500 (non-refundable, applies to camp tuition)
Security Fee (required): $100

Outstanding balance must be paid by 06/01/2024.

* Are you interested in paying the full registration price today?

Please Select OneYesNo

* Are you interested in paying the full registration price today?

Please Select OneYesNo

* Are you interested in paying the full registration price today?

Please Select OneYesNo

* Are you interested in paying the full registration price today?

Please Select OneYesNo

* Please check the box below to accept the $100 security fee.

Please check the box below to accept the $100 security fee.

Total Amount Due Today

* I understand that registration for the summer camp 2024 is not complete until the registration fee has been received by Camp Cohavim.

I understand that registration for the summer camp 2024 is not complete until the registration fee has been received by Camp Cohavim.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

* Signature (please type full name)

* Date