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Berkman Family Center Camp Enrollment Form
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Dear Families,
I am excited to welcome you to the Berkman Family Center at Rodef Shalom Congregation summer camp. Please complete the form below to begin the camp enrollment process. This form and payment of the deposit secures your child's enrollment for the Summer of 2024. Once we receive your enrollment, you will be sent the following documents:
1. Family Center Handbook
2. Child/Family Information Form
3. Child Health Appraisal Form
4. Tuition Agreement
5. ACH Debit Form
Please note that these documents and all deposit must be recieved no later than May 31, 2024.
As always if you have any questions, please reach out to me at feibus@rodefshalom.org
Best-
Ellie Feibus
Berkman Family Center Director
Camper Information
*
Please select the class you are enrolling your child in:
Please Select One
Toddler (18-24 Months)
Young Twos (24-30 Months)
Older Twos and Young Threes (31-36 Months)
Preschool (3.5-5 Years)
*
Please select the weeks you wish your child to attend:
Week 1 (June 17-21) $190
Week 2 (June 24-28) $190
Week 3 (July 1-5) $190
Week 4 (July 8-12) $190
Week 5 (July 15-19) $190
Week 6 (July 22-26) $190
Week 7 (July 29-August 2) $190
*
Child's Name:
*
Child Age:
*
Gender:
Parent/Guardian 1
*
First Name:
*
Last Name:
*
Email:
*
Daytime Phone/Cell:
*
Street Address
*
Add a second parent/guardian?
Please Select One
No
Yes
Parent/Guardian 2
*
First Name:
*
Last Name:
*
Email:
*
Daytime Phone/Cell:
Street Address (if different from Parent/Guardian 1)
Vaccination Policy
The Berkman Family Center at Rodef Shalom Congregation requires all children to be vaccinated in accordance with the schedule recommended by the CDC's Advisory Committee on Immunization Practices or be on an alternate vaccination schedule approved by their pediatrician. Vaccine records, a copy of the alternate schedule, and a health appraisal provided and signed by the pediatrician are required for enrollment.
*
I have read and understand the Berkman Family Center Vaccination Policy.
I have read and understand the Berkman Family Center Vaccination Policy.
Membership
Rodef Shalom Congregation members recieve a 10% tuition discount.
*
Are you a Rodef Shalom Congregation Member?
Please Select One
Yes
No
*
Are you interested in receiving information about becoming a member of Rodef Shalom Congregation?
Yes
No
Tuition Deposit
To reserve a space, a non-refundable deposit of $75 must be paid no later than May 31, 2024. Deposits will be deducted from tuition. Payment can be made through this form or by check made payable to Rodef Shalom Congregation.
Pay $75 deposit now by credit card.
Pay $75 deposit now by credit card.
Pay $75 deposit by check.
Pay $75 deposit by check.
Please make checks out to Rodef Shalom Congregation
Pay by May 31, 2024
Questions, Comments, and Special Circumstances
If you have any questions, comments, or special circumstances please share them below.
Total Due Now:
Fri, May 16 2025
18 Iyyar 5785
Tonight's Sefirah Count Is 34
היום ארבעה ושלשים יום שהם ארבעה שבועות וששה ימים לעמר
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Friday, May 16, 8:12pm
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Fri, May 16 2025 18 Iyyar 5785