5655 Thompson Road
DeWitt, NY 13214
315-445-2360
Fax: 315-449-4539
www.jccsyr.org
Spring
Break
April 3, 2015 – April 9, 2015
**The JCC will be closed Friday, April 10th in
observance of Passover**
The JCC’s Children’s Department is excited to present Vacation Camp fun for
your school-age children, grades K – 6. We’ll be having a blast during break
with activities like arts-n-crafts, field trips, sports, and more.
The daily program runs from 9:00 am to 4:00 pm with extended care starting
at 7:30 am and running to 6:00 pm. Half days, when available, are from 9:00
am to 12:00 noon or 1:00 pm to 4:00 pm.
Passover begins on the eve of April 3 – April 11. The JCC will also be closed
April 10th for Passover.
All campers should bring appropriate clothing including, sneakers for the
gym, and jackets and hats, as we will go outside most days. Campers should
also bring a Passover-style, non-meat lunch for each vacation camp day
during Passover, April 6th – April 9th. A snack will be provided in the
afternoon.
Submit the registration with payment by 3/27 to avoid
late fees and guarantee participation.
Friday, April 3, 2015
The JCC will close at 5pm today!
Rock Star Day!
Wednesday, April 8, 2015
Bowling
No ½ Day Option
AM: Create the ultimate rock star look with crazy hair
accessories and costumes.
Field Trip to Bowl More Lanes for bowling fun for all
ages. Enjoy some Minute to win it challenges upon
returning to the JCC.
PM: Perfect your dance skills and join us while we play
Just Dance in the afternoon.
**Passover Dietary Restrictions**
Monday, April 6, 2015
No ½ Day Option
IMAX at the MOST
Join us for a field trip to the MOST (Museum
of Science and Technology) for a day of
interactive exhibits, hands on science and time in the huge indoor science playhouse.
We will also see the movie The Grand Canyon in IMAX.
Thursday, April 9, 2015
Pajama Party
AM:
come in your pajamas for a cozy day of fun.
We will have dancing games in the lounge and a
jammin jammies relay race in the gym.
PM:
Slumber party with guessing games and a
movie on the big screen.
**Passover Dietary Restrictions**
Tuesday, April 7, 2015
Super Hero Day
Join us at the JCC and create your very own
superhero. We will have arts and crafts in the
morning and a superhero obstacle course in the
afternoon!
**Passover Dietary Restrictions**
**Passover Dietary Restrictions**
Friday, April 10, 2015
CLOSED
The JCC will be CLOSED on Friday in observance of Passover
Spring/ Passover Break
April 3, 6-9, 2015
CAMPER
My child is currently enrolled in the After School Program for the 2014-2015 school year. By checking this box, I indicate that all
information on file for After School with the Children’s Department is accurate and correct. Please complete only the camper’s first and
last name and payment information on this form for registration.
Last Name
First Name
Age
Address
M/F
City
State
Phone
Email
Birth date
School
Zip
Grade 2014-15
PARENT #1 / GUARDIAN INFORMATION
Last Name
First Name
Work Phone
Home Phone
Cell Phone
PARENT #2 / GUARDIAN INFORMATION
Last Name
First Name
Work Phone
Home Phone
Cell Phone
PAYMENT INFORMATION
Friday, April 3rd
Rock Star Day
Full Day
M $40 / NM $50
Half Day (circle one)
AM/PM
M $25 / NM $30
Monday, April 6th
The MOST and IMAX
Full Day
M $40 / NM $50
No ½ day option!
Tuesday, April 7th
Super Hero Day
Full Day
M $40 / NM $50
Half Day (circle one)
AM/PM
M $25 / NM $30
Wednesday, April 8th
Bowling
Full Day
M $40 / NM $50
No ½ day option!
Thursday, April 9th
Pajama Party
Full Day
M $40 / NM $50
Half Day (circle one)
AM/PM
M $25 / NM $30
The JCC will close at 5!
Payment
____Cash ____Check ____Charge
Signature
(circle)
Daily Totals
AM PM $__
Early/Late Care
M$2/NM$3/Free ASP
(circle) AM PM $__
Early/Late Care
M$2/NM$3/Free ASP
(circle) AM PM $__
Early/Late Care
M$2/NM$3/Free ASP
(circle) AM PM $__
Early/Late Care
M$2/NM$3/Free ASP
(circle) AM PM $__
Check if applicable
$15 Late charge for registration
st
Sibling Discount $5/ day (not 1 child, void after 3/27)
$5 x __ days = $_____
Daily Total $________ - Sibling Discount $_________
Early/Late Care
*M$2/NM$3/Free ASP
received after 3/27
+
Late Fee $ _________
= Grand Total $_________
Visa/MC # _________________________ Exp. ______
Spring/ Passover Break
April 3, 6-9, 2015
MEDICAL INFORMATION
Does your child have any allergies?
Yes
No
Please list all known:
I, ____________________________, agree to notify the Jewish Community Center’s Children’s Department each time my child has been medicated
or receives a treatment before coming to daycare. I will inform them of the name of the medication, the time it was given, and any side effects they
should be aware of.
Parent’s Initials ________
Please list medications here:
***If your child requires medication administration of any kind, including epi-pens or inhalers, you must complete additional paperwork prior to your
child attending Vacation Camp. Please request this form when registering from the Children’s Department.
HEALTH CONCERNS
Are there any special health conditions/concerns that could help us to better serve your child?
MEDICAL CONTACTS
Physician
Address
Phone #
Dentist
Address
Phone #
Preferred Medical Facility
Phone #
INSURANCE
Insurance Policy/Carrier
Policy/Group #
EMERGENCY CONTACT INFORMATION (Other than parent) MUST BE LOCAL
Name
Day Phone
Relationship
Name
Day Phone
Relationship
EMERGENCY AUTHORIZATION
I hereby appoint the appropriate JCC staff members to act on my behalf in authorizing unexpected medical, dental, or surgical care
and/or hospitalization for the below named minor during the period of _________________________ (start date) through June 30,
2015 in the event of my unavailability.
Child’s Name
D.O.B.
Parent Signature
Date
Witness Signature
Date
PUBLICITY RELEASE
I give permission for my son/daughter _________________________ to be used in any after school/camp publicity or promotion.
Parent’s Initials ________