JCC Summer Camp
2010 Enrollment Form
JCC of Dutchess County 110 S Grand Ave. Poughkeepsie, NY 12603 471-0430
Child’s name
___________________________________________
Date of
Birth_________________________________________
Address:______________________________________________
City/Zip
______________________________________________
Mother’s name:
_________________________________________
Day time phone:
______________________________________
Father’s name:
__________________________________________
Day time
phone:________________________________________
Camp Group:
Camp Weeks:
_____________________________________________
_________________________________________________________
Fees:
Camp Buddies $168 M/ $220 NM 9-1
per camp week
$ 220 M/ 273 NM 9-4
per camp week
Explorers and $220
M/ $273 NM 9-4 per camp week
Adventurers
There is a
10% camp fee reduction for siblings
Amount
Due:___________________________
Payments may be made by check, cash, Visa or
Mastercard
Credit
card # _____________________ Exp
date______________
Name
on Card ____________________________
Signature:______________________________
All checks should be made payable to The JCC
of Dutchess County
*Payment
must be received in full by June 29, 20089,
late registration based on availability
A $100 non refundable and not transferable deposit
is required at the time of registration.
Cancellation Policy
Before
May 31, 2009 50% (less deposit) Before June 15, 2009 25% (less deposit)
After June 15, 2009 No refund
*****JCC reserves the right to cancel any class
due to insufficient registration.
However the JCC cannot compensate or provide make ups for children who
miss programs for reasons of their own.
I fully understand the JCC’s refund and
cancellation policy
Parent
Signature____________________________ Date _________________
A current physical and vaccination form must be on
file in the ECC office prior to the start of camp.