Y'ladim BaTeva Summer Forest Adventure 2024

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Please complete a separate form for each child.

PART ONE - About This Child

Child's name *

Please write first and last name. If your child goes by a nickname, please write that after their full name in parentheses. (Example: "Paul Jones (Paulie)"

Child age as of 7/8/24 *

Child grade as of FALL 2024 *

Below, please check any that apply. *

This information will be kept confidential. In the question below, there is space to explain in further detail any needs this child may have that is important for staff to know and could impact their experience at this program.

food allergy

environmental allergy (i.e., plants, bugs)

chemical sensitivity

physical limitation

neurodiversity

emotional needs

no issues that could impact my child's camp experience

Other:

Required

If you indicated above that your child has needs we should be aware of, please explain further.

The cost for this program is $300 for early bird registration and payment by April 1; $350 from April 2-July 1; or $400 after July 1. Please check below how you will be paying for this program. *

If you are registering more than one child, you can make one payment for all.

by check made out to Ma'yan Tikvah with Summer Adventure in the memo line

with cash

via Paypal

Please indicate the cost for this child for the program, based on your registration and payment date. *

Type that amount in the space below.

PART TWO - Parent/Caregiver

Primary parent/caregiver full name *

Primary parent/caregiver phone *

Please list at least two phone numbers, if possible. After each, indicate what type of number it is. (HOME, MOBILE or WORK). Indicate preferred number with a *.

Primary parent/caregiver preferred email address *

Primary parent/caregiver mailing address *

Additional parent/caregiver name(s) and relationship to child

Additional parent/caregiver phone(s)

Indicate what type of number it is. (HOME, MOBILE or WORK). Indicated preferred number with a *.

Additional parent/caregiver mailing address(es)

Photography *

Please check the appropriate box regarding photographing your child:

Ma'yan Tikvah has my permission to use my child's photograph publicly for promotion. I understand that my child’s name will not be used, and that the images may be used in print publications, online publications, presentations, websites, and social media.

May'an Tikvah has my permission to photograph my child but to only share the photos with other parents/caregivers.

I do not want my child to be photographed.

Required

BY CHECKING THE 'YES' BOX BELOW, I indicate that that I have provided full and accurate information about my child, as it relates to this child participating in this program. I am aware that it is my responsibility to arrange transportation for my child to and from the program each day, that program locations will be different each day, that the group will leave the parking lot soon after 9 each day, and that late arrival could hold up the group. I am aware that this program requires my child be picked up no more than fifteen (15) minutes after the end of each program day. I am aware that there are risks inherent to being outside, and I give permission for my child to be engaged in these program activities. I am aware that my child's registration will not be complete until the Waiver forms (provided after submitting this registration form) are completed and returned and payment has been made, and that I will receive additional information before the start of this program. *

yes

Required

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