CBS Camp Chaverim Registration 2022

Our camp and campers will be following all COVID-19 safety guideline provided by the state and county, and we are modeling our policies after those of the Napa Valley Unified School District. We are not currently requiring COVID-19 vaccination for children, but will add that requirement if NVUSD requires vaccination for the 2022-2023 school year.

We anticipate that we may ask about Covid vaccination status for planning purposes.

Camper Information:

* First Name:

* Last Name:

* Birthday:

* Grade in Fall of 2022

* Address:

* City:

* Zip

What is most important about your child’s experience at Camp Chaverim?

Please share anything you feel is important for us to know about your child for their optimum experience:

Do you have a skill, talent, ability, hobby or passion you would be willing to share with our campers?

Is there anything else you would like us to know about your child?

Parent #1 Information:

* First Name:

* Last Name:

* E-mail:

Home #:

* Cell #:

Work #:

Parent #2 Information:

First Name:

Last Name:

E-mail:

Home #:

Cell #:

Work #:

Emergency Contact Information:

Person(s) OTHER THAN PARENTS/GUARDIANS in case parents are unable to be reached.

* Emergency Contact Name:

* Emergency Contact Phone Number:

Emergency Contact Name:

Emergency Contact Phone Number:

Person(s) OTHER THAN PARENTS authorized to pick up camper:

Pick Up Contact Name:

Pick Up Contact Phone Number:

Pick Up Contact Name:

Pick Up Contact Phone Number:

Medical Information:

Physician:

Phone:

Dentist:

Phone:

* Medical Insurance:

* Medical Insurance Policy Number:

* Allergies:

Please list any allergies your child has. If none, list "N/A"

* Medications:

Please list any medications your child is taking and the frequency. If none, list "N/A"

Permission and Medical Release Form:

I/We hereby give permission for my child to be transported by camp transportation and to be supervised by camp staff and volunteers during all camp programs and field trips. My child may participate in all camp activities. I agree to abide by all Camp Chaverim rules, policies and regulations. I acknowledge that photos/video will be taken during camp for promotional purposes.

I/We, the undersigned, parent(s) or guardian(s) of:

Camper Name:

a minor, do hereby authorize the directors of Camp Chaverim and Congregation Beth Shalom of Napa Valley, or their authorized representatives, as agents for the undersigned, to consent to medical treatment by a state licensed physician, or staff of a licensed hospital to be administered to my child in the event of accident, injury, sickness, etc., until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release shall remain in effect at all times during Camp Chaverim Summer Session 2022.

Name of Parent/Guardian:

Date:

Registration Deadline: June 7, 2022

Early registration is recommended to reserve your child’s spot.

Refunds will not be made for campers who withdraw from camp after June 1^st, unless due to serious illness or due to COVID guidelines where we must cancel camp.

* Please check this box to acknowledge that you have read the refund policy above.

Please check this box to acknowledge that you have read the refund policy above.

Tuition & Payment Information:

Camp Chaverim T-shirt and all activities are included in camp tuition.

Note that Camp Chaverim will NOT be held on Mon. July 4.

WEEK #1: June 27-July 1, 9 AM - 3:30 PM

Members - $225Non-Members - $250

WEEK #2: July 5-July 8, 9 AM - 3:30 PM

Members - $180Non-Members - $205

Optional Extended Care

We plan to offer extended care each day from 8 am to 5 pm. However, we may not be able to run extended care if we do not have at least three children signed up per day by June 7. If we are not able to run extended care, we will let you know and you will receive a refund for the cost of the extended care.

Methods of Payment:

Select applicable discounts:

Multi-session discount $15

N/AMulti-session discount

Sibling discount $15

N/ASibling discount

Total Amount Due

Please Sign and click the Submit button below to proceed to the payment page.

Signature (please type full name)