(215) 698-7300 x146
10100 Jamison Ave, Philadelphia, PA 19116
Klein JCC Summer Day Camp Application
Monday, June 22nd, 2015- Friday, August 14th, 2015
Camper Name (Last/First Name): _________________________________________Gender: ___Boy ____ Girl
Address: ______________________________________________________________________________
City: ___________________________________________________ State: _________ Zip: _________
Primary Phone: (
) _______________Circle One: home cell work Birthdate: ___/___/______
Age as of 6/1/2015 ______ Grade starting September 2015 ______ T-Shirt Size XS S M L XL Youth/Adult
Please tell us who the child lives with:
Adult #1 Name: _______________________Cell Phone: (
Adult #1 - ____Parent
____ Step Parent
Adult #2 Name: _______________________Cell Phone: (
Adult #2 - ____Parent
____ Step Parent
)____________ Email Address: ______________
____ Guardian
__ Other: ____________
)____________ Email Address: ______________
____ Guardian
__ Other: ____________
CAMP OPTIONS: (Please Check one from each column)
Check One Age Group
Lower Camp (Grades- K-3rd)
Sr. Girls Camp (Grades: 4th-7th)
Maccabi Boys Sports Camp (Grades 4th-7th)
CIT Camp (Grades 8th & 9th)
Extended Care:
Check One
Camp Sessions
Full- 8wks (6/22-8/14)
6wks- Dates:
4wks- Dates:
__wks- Dates:
_______ Early Care (7:00am-9:00am) Circle Please: Mon Tues Wed Thur Frid
_______ Late Care (4:00pm-6:00p) Circle Please: Mon Tues Wed Thur Frid
-------------------------------------------------------------------------------------------------------------------------------------------------IMPORTANT IMFORMATION:
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All Camp balances must be paid in full by June 26th, 2015.
We accept CCIS!
Early and Late Care is included in the camp tuition.
If financial Assistance is requested please contact Andy Newman at (215) 698-7300 x146 or at
[email protected].
Camp Prices located on the back of the form.
(215) 698-7300 x146
10100 Jamison Ave, Philadelphia, PA 19116
2015 Camp Prices
8 Weeks
4 Weeks
Lower Camp
(Grades K-3rd)
$1,700.00
$1,100.00
Maccabi Boys Sports Camp
(Grades 4th-7th)
$1,950.00
$1,350.00
Sr. Girls Camp
(Grades 4th-7th)
$1,800.00
$1,200.00
CIT Program
(Grades 8th & 9th)
$1,000.00
$600.00
 What is included in your camp tuition?
o Camp Day activities!
o Early Care and/or Late Care
o Lunch *New for 2015 Season
o Camp Trips
o Specials Shows
o & More!
Parent’s Signature _____________________________________________________ Date _______________
----------------------------------------------------------------------------------------------------------------------------------------------OFFICE USE ONLY:
Amount Due by 6/26/2015: $________________
Start Date: ________________
End Date: _________________
Staff Signature: __________________________________________
Other: ________________________________________________________________________________
______________________________________________________________________________________