Grades K thru 9 Registra on Packet

2019 Camp Informa on K thru 9 JCC Summer Camps Grades K thru 9 Registra on Packet Welcome to summer camp at the JCC! We are so excited to show you and your family why J Camp is Life! JCC Membership required PRIOR to Camp Registra on If your family is not currently a J Member, you must join as a Camp Friend (a JCC membership only for the me your child is in camp) before this registra on packet will be accepted. To become a J member for no more than $88 a month, please contact our Membership department. If joining as a Camp Friend, a Camp Friend Registra on Form must be completed and the en re Camp Friend fee MUST accompany this registra on. Camp Friend Fees are: $525 per family for 6 9 weeks of camp $280 per family for 2 5 weeks of camp $100 per camper when registering for a single week of camp View the benefits of membership at www.jccdallas.org/join and contact our Membership department at 214 239 7138 with any ques ons. Registra on Process To register your child(ren) for camp: Please complete one packet per child The packet must be completed in its en rety and submi ed to the JCC Front Desk or jcamp@jccdallas.org Receipt of these forms by the JCC does not guarantee a space in the camp of your choice. If we are unable to accommodate your camper in the camp of your choice, a Camp Director will reach out to you directly to a empt to make alterna ve arrangements. If we cannot make alterna ve arrangements, your camper will not be registered for camp and camp fees will not apply. Important Camp Registra on Dates Camp registra on forms will be accepted based on the following schedule: Priority Registra on for J Members opens at 12:30pm on Sunday, January 20, 2019. Families may join the JCC as J Members on January 20, 2019 to receive the benefit of priority registra on. Camp Friends may also submit this packet beginning at 12:30pm on Sunday, January 20, 2019; however, your forms will be held for processing un l Sunday, January 27, 2019 when registra on opens to the community. Completed forms will be processed in the order they are received. In person registra ons receive date/ me stamps, and emailed, faxed, or mailed forms will be stamped as if they were turned in at the END of day they were received. Forms submi ed prior to January 20th will NOT be accepted. Refund and Change Policies Please be sure to read the camp refund and change policies on the Waiver and Release form inside this packet. Ques ons? If you have any specific ques ons about a camp, you may reach out to the Camp Director (Contact informa on for each Camp Director can be found on the individual camp pages at www.jccdallas.org/camps). If you have ques ons about the camp registra on process or your specific situa on, please contact Anna Miller Goodman at agoodman@jccdallas.org or 214 239 7125 before submi ng your registra on packet. K thru 9 Camp Informa on, Page I

2019 Parent s Checklist K thru 9 JCC Summer Camps We are looking forward to your child joining us at JCC Camps this summer! Please complete the following steps to register for camp. Step 1: For each child, please complete the registra on forms in this packet in its en rety and return them to the JCC Front Desk. Step 2: The following forms must be completed for each camp that your child(ren) will a end. Please complete all necessary forms and turn in to the JCC no later than June 1, 2019 (or ASAP if a er this date). Forms can be found online at www.jccdallas.org/campforms. If you have any ques ons or concerns about a specific camp, please contact the individual Camp Director (Contact informa on for each Camp Director can be found on the individual camp s page at www.jccdallas.org/camps). Ques ons about forms required for All Camps can be directed to Anna Miller Goodman at agoodman@jccdallas.org or 214 239 7125. FORMS FOR ALL CAMPS: Camp Friend Registra on Applica on if your family is not a J Member Camper Informa on Form* Waiver and Release* Registra on Form* Camp Health Form (Immuniza on record and Doctor s signature(s) with date of most recent wellness exam. Note: date of exam must be within one year of camper star ng camp) Ge ng to Know You Form** (Online submission at www.jccdallas.org/campforms) **Please complete ASAP if registering for Gymnas cs Camp *included in this registra on packet FORMS THAT MAY BE REQUIRED (based on your family s individual situa on): Medica on Release Form if camp staff will be administering any medica ons to your child (Online submission at www.jccdallas.org/campforms) Carpool Form if any children outside of your household will be carpooling with your family (Online submission at www.jccdallas.org/campforms) Step 3: Your child s Camp Director(s) will reach out with more informa on about camp prior to camp star ng! K thru 9 Camp Informa on, Page II

2019 Camper Informa on Form K thru 9 JCC Summer Camps Camper Informa on: Full Name: Gender: [ ] Male [ ] Female Birthdate: / / _ Grade (as of 9/1/19) : School: Home Phone: Home Address: City: Zip: Child Resides With: [ ] Parent 1 and/or [ ] Parent 2 Non Custodial Parent Address (if Applicable): Address: City: Zip: Parent 1 Informa on: Name: Primary Phone: Secondary Phone: Email: Parent 2 Informa on: Name: Primary Phone: Secondary Phone: Email: Medical Informa on: Insurance Carrier: Policy Holder: Policy Number: Physician Name: Physician Phone Number: [ ]Yes or [ ]No : Does the camper have any Allergies? If yes, please provide details: [ ]Yes or [ ]No : Does the camper take any medica ons? (Please note that Medica on Release Form MUST be completed for any medica on to be administered by camp staff) If yes, please provide details: [ ]Yes or [ ]No : Does the camper have any addi onal medical condi on(s) that camp staff should be aware of? If yes, please provide details: Emergency Authoriza on: When no parent can be reached, the following may act on my behalf and my camper may be released to (individuals listed below may have access to health informa on about my child): [ ] Emergency Authoriza on Granted to the following individual(s) or [ ] No Emergency Authoriza on Granted Name: Rela on to Child: Primary Phone: _ Secondary Phone: _ Name: Rela on to Child: Primary Phone: _ Secondary Phone: _ To the best of my knowledge, the informa on contained above is true, complete, and accurate. I understand that if any of the informa on above should change, a new Camper Informa on Form should be submi ed to the JCC of Dallas as soon as possible. Signature of Parent : Date: / _ / _ K thru 9 Camp Registra on Packet, Page 1 of 5

2019 Waiver and Release K thru 9 JCC Summer Camps Camper s Full Name: Grade (as of 9/1/19): _ REFUND, TRANSFER, AND CHANGE POLICIES 1) Camp s MUST accompany this applica on. s are NOT REFUNDABLE for any reason. 2) Camp s ARE FORFEITED if camper is dropping out or reducing the total me for a camp item (week, session, bus, AM and/or PM care, etc). 3) Transfers and changes are based on availability. A er April 1, 2019 there will be a $50 fee per transfer or change. 4) Complete payment for all sessions is due on or before April 28, 2019. 5) A er May 1, 2019, no refunds will be granted. 6) A er camp has begun, an addi onal 3 week session is $100 more than the 6 or 9 week fee. PARTICIPANT WAIVER AND RELEASE OF LIABILITIES With the realiza on that publicity of programs helps ensure the success of the programs, I hereby grant the Jewish Community Center of Dallas (JCC) full permission to use my/our full name, personal success story, photographs, films, and video of me/my family for the purpose of publicizing the Center. This permission includes but is not limited to iden fica on of my child by name in printed materials, reports, grants, website, Facebook, and other social media. The JCC of Dallas reserves the right to reconsider your child s enrollment if per nent informa on regarding medical, psychological, educa onal, or other relevant evalua on or medical care has not been adequately shared with the camp administra on. If we are unable to accommodate your child s level of func on or if their behavior limits their ability to par cipate in or benefit from our camp program, we reserve the right to reconsider your child s a endance. I give my permission for my child/children to par cipate in all ac vi es of the Jewish Community Center of Dallas, including swimming and field trips (if applicable). I understand that on field trips my child/children will be transported by bus or private automobile (required to par cipate in any camp programming). In the event of an emergency which affects the health of the camper I, undersigned, do hereby authorize officials of the JEWISH COMMUNITY CENTER OF DALLAS to contact directly the persons named on the a ached Camper Informa on Form and if neither parent nor guardian can be contacted, I authorize the physician named on the a ached Camper Informa on Form to render such treatment as may be deemed necessary in an emergency, for the health of the child. I hereby give the personnel of the Jewish Community Center of Dallas permission to make arrangements for emergency medical a en on, to transport the student to an accredited facility for diagnosis and treatment and to authorize emergency administra on of medica on as necessary. I request and authorize physicians, den sts, and staff of the accredited medical facility to perform any diagnos c procedures, treatment procedures, x ray treatments and administra on of anesthe cs as may be necessary in the diagnosis and treatment of minor camper. I understand that I have not been given a guarantee as to the results of examina on or treatment. I agree to pay for the services rendered and expenses incurred pursuant to this authoriza on. Further, I will not hold the Jewish Community Center of Dallas or their Officers, Directors, Administrators, Teachers, Personnel or Employees financially responsible for the emergency care and/or transporta on for said child. The authority granted herein will expire one year from acknowledged date. This is to cer fy that I, as parent/guardian with legal responsibility for the above named Par cipant on behalf of the par cipant do consent and agree to his/her waiver and release as provided above of all the Releases, and, for myself, my spouse or co guardian, heirs, assigns, and next of kin, waive, release and agree to indemnify and hold harmless the Releases from any and all liability, other than gross negligence as defined by Texas law, associated with my minor child s involvement or par cipa on in these programs, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permi ed by law. In considera on of being allowed to par cipate in any way in any program, related events and ac vi es at the JCC or sponsored by the JCC ( programs ) I on my own behalf and on behalf of any minor children for whom I am responsible appreciate and agree that: 1) The risk of injury from the ac vi es involved in programs offered by the JCC may be significant, including the poten al for permanent injury or even more serious consequences, and while par cular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist, and; 2) On my own behalf and on behalf of any minor children for whom I have responsibility, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE JCC, other than gross negligence as defined by Texas law, and those affiliated with the JCC described in Paragraph 4 or others, and assume full responsibility for my and my minor children s par cipa on. If anyone in my family violates any rule or policy of the JCC or otherwise causes a problem that in the sole discre on of the JCC CEO endangers the health, safety or welfare of anyone, the CEO may suspend my family s privilege to be on the JCC campus and par cipate in the JCC s programs, and; 3) I willingly agree to comply with the stated and customary terms and condi ons for par cipa on. If I observe any unusual significant hazard during my presence or par cipa on, I will remove myself and my minor children from par cipa on and bring such to the a en on of the nearest official immediately. 4) I, for myself and on behalf of my minor children, heirs, assigns, personal representa ves and next of kin, HEREBY WAIVE, RE LEASE, INDEMNIFY, AND HOLD HARMLESS THE JCC, their officers, officials, agents and/or employees, other par cipants, sponsoring agencies, sponsors, and, if applicable, owners and lessors (referred to as Releases ) FOR ALL CLAIMS other than gross negligence as defined in Texas law in connec on with any conduct regarding any program at the JCC or any ac vity sponsored by the JCC WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permi ed by law. I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Signature of Parent : Date: / _ / _ K thru 9 Camp Registra on Packet, Page 2 of 5

2019 K thru 9 JCC Summer Camps Registra on Page 1 of 3 Please complete a separate applica on for each camper and indicate which camp(s) and extra(s) you would like to register for. Total the camp fees and deposits on page 3. Note: Campers must be either J Members OR pay the addi onal Camp Friend fee. Camper s Full Name: Grade (as of 9/1/19): _ Camper s Membership Number: T Shirt Size (Please Select One): [ ] Youth S 6 8 [ ] Youth M 10 12 [ ] Youth L 14 16 [ ] Adult S 34 36 [ ] Adult M 38 40 [ ] Adult L 42 44 [ ] Adult XL 46 48 Session & Week Dates Pricing Deadlines Chai, Gymnas cs, Tennis, and Sports Camps $_ $_ Session 1, Tue, June 11 Fri, Jun 28 No camp on Mon, Jun 10th Week 1, Tue, Jun 11 Fri, Jun 14 Week 2, Mon, Jun 17 Fri, Jun 21 Week 3, Mon, Jun 24 Fri, Jun 28 SESSION PRICING: One Session Only Early $1,026, Regular $1,131, Late $1,206, $150 Two Sessions Only Early $1,704, Regular $1,866, Late $2,004, $300 All Three Sessions Early $2,295, Regular $2,520, Late $2,682, $450 WEEKLY PRICING: Early $371 Regular $405 Late $415 Weekly $100 Pricing above is per week Mul ply weekly price by number of weeks to determine full cost Weekly space is limited. Camp Director approval required. Session 2, Mon, Jul 1 Fri, Jul 19 No camp on Thu, Jul 4th Week 4, Mon, Jul 1 Fri, Jul 5 Week 5, Mon, Jul 8 Fri, Jul 12 Week 6, Mon, Jul 15 Fri, Jul 19 Early, On or Before March 1 Regular, March 2 May 1 Late, A er May 1 Session 1 Jun 11 Jun 28 Camp Chai Gymnas cs Camp Tennis Camp Sports Camp Sports Camp StarQuest AND StarPower Performing Arts Camps Tennis Camp Select one Camp per session Session 2 Jul 1 Jul 19 Camp Chai Gymnas cs Camp Tennis Camp Sports Camp Camp Chai Session 3, Mon, Jul 22 Fri, Aug 9 Week 7, Mon, Jul 22 Fri, Jul 26 Week 8, Mon, Jul 29 Fri, Aug 2 Week 9, Mon, Aug 5 Fri, Aug 9 Session 3 Jul 22 Aug 9 Camp Chai Gymnas cs Camp Tennis Camp Gymnas cs Camp StarQuest + StarPower (weeks 1 7), Early: $2,422, Regular: $2,667, Late: $2,826. $350 StarQuest + StarPower + 2 wks (Full Summer), Early: $2,932, Regular: $3,227, Late: $3,422. $450 REQUIRED: Select one 2 week camp for Weeks 8 & 9: [ ] Chai or [ ] Tennis J Performing Arts Camps Grades 3 9 $_ $_ StarQuest 4 week Musical Theater & Performing Arts Intensive StarQuest (weeks 1 4), Early: $1,396, Regular: $1,536, Late: $1,620. $200 StarQuest + 2 weeks (weeks 1 6), Early: $1,964, Regular: $2,158, Late: $2,288. $300 REQUIRED: Select one 2 week camp for Weeks 5 & 6: [ ]Chai [ ] Sports or [ ] Tennis StarQuest + 5 weeks (Full Summer), Early: $2,671, Regular: $2,936, Late: $3,110. $450 REQUIRED: Select one 2 week camp for Weeks 5 & 6: [ ] Chai [ ] Sports or [ ] Tennis REQUIRED: Select one Session 3 camp: [ ] Chai [ ] Tennis or [ ] Gymnastics StarPower 3 week Creative Expression, Mindfulness & Artistry Camp StarPower (weeks 5 7), Early: $1,026, Regular: $1,131, Late: $1,206. $150 StarPower + 3 weeks (Sessions 2 & 3), Early: $1,878, Regular: $2,064, Late: $2,208. $300 REQUIRED: Select one camp for Weeks 4, 8 & 9: [ ]Chai or [ ] Tennis StarPower + 6 weeks (Full Summer), Early: $2,556, Regular: $2,811, Late: $2,994. $450 REQUIRED: Select one camp for Session 1: [ ] Chai [ ] Sports [ ] Tennis or [ ] Gymnastics REQUIRED: Select one camp for Weeks 4, 8 & 9: [ ]Chai or [ ] Tennis K thru 9 Camp Registra on Packet, Page 3 of 5

Please complete a separate applica on for each camper and indicate which camp(s) or extra(s) you would like to register for. Total the camp fees and deposit due on page 7 of the Registra on Packet (next page). Note: Campers must be either J Members OR pay the addi onal Camp Friend fee. Camper s Full Name: Grade (as of 9/1/19): _ Camper s Membership Number: Session & Week Dates Pricing Deadlines Teen Travel Camp Grades 7 9 $ $ Camp Extras (Extended Care and Buses) $ $ 2019 K thru 9 JCC Summer Camps Registra on Page 2 of 3 Session 1, Tue, Jun 11 Fri, Jun 28 No camp on Mon, Jun 10th Week 1, Tue, Jun 11 Fri, Jun 14 Week 2, Mon, Jun 17 Fri, Jun 21 Week 3, Mon, Jun 24 Fri, Jun 28 COMBO PRICING: Weeks 1 3*, Early/Regular: $2,223, Late: $2,310. $350 Weeks 4 7*, Early/Regular: $2,180, Late: $2,312. $350 Weeks 1 7*, Early/Regular: $4,370, Late: $4,580. $700 *If registering a er May 1, camper may need to purchase their own plane cket. Contact Abbii at acook@jccdallas.org with any ques ons. ZTX Membership TTC/Maccabi Par cipants: $175 per teen membership available for Maccabi and/or TTC. Covers any Maccabi / TTC ac vi es and is good from Feb Aug 19. Teen MUST be 11 16 years of age and par cipa ng in Maccabi/TTC to be eligible for this membership type! Please see www.jccdallas.org/ c for more details EXTENDED CARE BY SESSION Morning (7:30am Start) Cost $84 per session EXTENDED CARE BY WEEK Morning (7:30am Start) Cost $35 per week Session 2, Mon, Jul 1 Fri, Jul 19 No camp on Thu, July 4th Week 4, Mon, Jul 1 Fri, Jul 5 Week 5, Mon, Jul 8 Fri, Jul 12 Week 6, Mon, Jul 15 Fri, Jul 19 Early, On or Before March 1 Regular, March 2 May 1 Late, A er May 1 A ernoon (6:00pm End) Cost $144 per session A ernoon (6:00pm End) Cost $63 per week Session 3, Mon, Jul 22 Fri, Aug 9 Week 7, Mon, Jul 22 Fri, Jul 26 Week 8, Mon, Jul 29 Fri, Aug 2 Week 9, Mon, Aug 5 Fri, Aug 9 INDIVIDUAL WEEKS: Week 1: Early/Regular: $380, Late: $425, $100 deposit Week 2*: Toronto Trek, Jun 16 21 Early/Regular/Late: $1,500, $200 deposit Week 3: Early/Regular: $380, Late: $425, $100 deposit Week 4: Early/Regular: $380, Late: $425, $100 deposit Week 5*: Memphis Trek, Jul 7 12 Early/Regular/Late: $1,095, $200 deposit Week 6: Early/Regular: $380, Late: $425, $100 deposit Week 7: Early/Regular: $380, Late: $425, $100 deposit Bus Stop Bren ield Elementary North Dallas (Hillcrest & Frankford) Plano (Kohl s @ Spring Creek & Ohio) Frisco (Main Event) One Way AM Cost $126 per session One Way AM Cost $48 per week BUS TRANSPORTATION BUS TRANSPORTATION BY SESSION One Way PM Cost $126 per session BUS TRANSPORTATION BY WEEK One Way PM Cost $48 per week Both Ways Cost $174 per session Both Ways Cost $64 per week K thru 9 Camp Registra on Packet, Page 4 of 5

2019 K thru 9 JCC Summer Camps Registra on Page 3 of 3 Camper s Full Name: Grade (as of 9/1/19): _ Camper s Membership Number: J Members Camp Friends / ZTX Members Camp Fees from Registra on Page 1 $_ Teen Travel Camp Fees from Page 2 $_ Camp Extras from Page 2 $_ Total Camp Fees Due $_ Camp (s) Due: $_ Remaining Balance (Due by Apr 28) $_ (Total Camp Fees less s) Camp Fees from Registra on Page 1 $_ Teen Travel Camp Fees (from Page 2) $_ Camp Extras (from Page 2) $_ + Camp Friend / ZTX Fee* $_ *fee must be paid in full at registra on Total Camp Fees Due $_ Camp (s) Due $_ + Camp Friend / ZTX Fee $_ Total to be Paid Today: $_ (Minimum due is the Camp ) Pay in full today Remaining Balance (Due by Apr 28) $_ (Total Camp Fees less Camp Friend/ZTX and s) Total to be Paid Today $_ (Minimum due is Camp + Camp Friend or ZTX ) Pay deposits today and remaining balance on April 28, 2019 Pay deposits today and equal monthly payments with balance paid by April 28, 2019 Please check preferred date of payment: 7 th 15 th 21 st 28 th I authorize the Jewish Community Center of Dallas to charge my credit card below per the above payment plan: Credit Card Number (VISA or MasterCard) Expira on Date Signature Date For JCC Use Only: Amount Received: $ Camp Paid by: [ ] Credit Card [ ] Check (enclosed) or [ ] Cash Preliminary Review and Approval By (please ini al): K thru 9 Camp Registra on Packet, Page 5 of 5