Camp Shalom Enrollment Form 2022

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This is an extensive form obtaining information about the camper/s, the parent/guardian, medical information and releases, etc. Please allow 30 minutes to complete this form.

Please complete as soon as possible so we can best plan for your camper!

Camp Shalom has 2 one-week sessions: June 13-17 and June 20-24.
Camp hours are Mon-Thurs 9:00 - 12:30, and Fridays 9:00 - 1:30.
Camp Shalom will be located at the WJCC.
Camp Shalom campers are ages 4 - 11 and must be toilet-trained.

Camp costs $145 per week per camper. To receive the early bird rate of $125 per week per camper, complete this form by May 20.

Checks can be made out to MKJF and mailed to 1850 N. Woodlawn St, Wichita, 67208, or brought in the first day of camp.

Cantor Paula Pepperstone is the Camp Director, and Samantha Taylor is the Assistant Director.
If you have any questions, please contact Cantor Pepperstone at 315-427-4737 or CantorPepperstone@gmail.com.

FIRST CAMPER'S INFORMATION

This camper is registering for: *

Week 1 - June 13-17

Week 2 - June 20-24

Both

Other:

A family member is welcome to attend our pre-Shabbat lunches on Fridays at 12:30 with their camper/s. A family member or I will be there on: *

Yes, on June 17

Yes, on June 24

Both

I'm not available.

I'm not sure yet. Please check in with my closer to the date.

Other:

Camper's First Name *

Camper's Last Name *

Camper's preferred pronouns:

Camper's Home Address *

City *

Zip Code *

Home phone number

Birthdate *

YYYY

Camper's school *

Grade in FALL 2022 *

SUNSCREEN: *

I give permission for Camp staff to apply sunscreen to my camper/s.

My camper needs special sunscreen due to allergies or sensitivities, and I, as the parent/guardian, will provide the sunscreen in a bag with the camper's name on the outside. Sign here:

Does your camper receive accommodations during the school year that would be helpful for us to know about? *

Yes

Does your camper receive accommodations during the school year that would be helpful for us to know about? *

Yes

If yes, please include information to help us best meet their needs.

Does your camper have allergies or a medical condition that Camp Shalom should be aware of? *

Yes

If yes, please include information to help us keep your camper safe.

Do you have another camper to register? *

Yes

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