Adventure rabbi

Camp Adventure Rabbi
Boulder, Colorado
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We have room for you!
Registration for Camp Adventure Rabbi:

 


   

Contract: This form will serve as a contractual agreement for enrollment in the Camp Adventure Rabbi program.

Please include phone numbers where you can be reaching during the sessions.

Please provide the following:
Parent #1 Contact Information:
Parent #1 Name 
Parent #1 Email 
Parent #1 Phone 
Parent #2 Contact Information:
(If there is only one parent, leave this section blank)
Parent #2 Name 
Parent #2 Email 
Parent #2 Phone 
Student #1 Information:
Student #1 Name 
Student #1 Birthday 
Student #1 Grade Entering 
Student #1 Allergies
/ Medical Conditions? 

Note: We are unable to take students with severe / life-threatening allergies at this time.
Special Needs /
Learning  
Disabilities? 

Please let us know if your child has learning disabilities or special needs for learning.
Student #2 Information: (If you have two students in program)
Select:  

Student #2 Name 
Student #2 Birthday 
Student #2 Grade Entering 
Student #2 Allergies
/ Medical Conditions? 

Note: We are unable to take students with severe / life-threatening allergies at this time.
Special Needs /
Learning  
Disabilities? 

Please let us know if your child has learning disabilities or special needs for learning.
Student #3 Information: (If you have three students in program)
Select:   Check if you'd like to register a third child into Camp Adventure Rabbi
Student #3 Name 
Student #3 Birthday 
Student #3 Grade Entering 
Student #3 Allergies
/ Medical Conditions? 

Note: We are unable to take students with severe / life-threatening allergies at this time.
Special Needs /
Learning  
Disabilities? 

Please let us know if your child has learning disabilities or special needs for learning.
Additional Emergency Contact Information:
Contact 1 Name: 
Contact 1 Phone: 

Contact 2 Name: 
Contact 2 Phone:

Names of people who have permission to pick up your child:

If you have "do not release to" information, please share that here: 
Pricing (Non-Member):

Please select # of Non-Members ($300 for non-members):

2 Camper (Non-Members) = $600

3 Campers (Non-Members) = $900

None

   
Pricing (Members):

Please select # of Member Camper:


2 Campers (Members) = $500
3 Campers (Members) = $750
None

 

Tuition Insurance:

 

 
Billing Information:
Name on Card 
Billing Address 
City 
State 
Zip 
Payment Method 
Card Number 
Exp. Date 
Code on Back of Card 
Comments: 
Terms,
Conditions
& Waiver: 

 <-- Please Enter your Initials to Agree
       to the Terms, Conditions and Waiver.

 

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