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SPRING BREAK CAMP Monday, March 23 – Friday, March 27
General Camp | Pre-K - 5th Grade
Campers will enjoy all their favorite on-campus activities including sports, swimming, music, crafts, cooking, as well as on-campus entertainment and more! Campers will swim daily, please bring a swimsuit, towel, flip flops and sunscreen. Field trip included (not for Pre-K campers).
9 am - 4 pm
Sports Camp | K - 5th Grade
Sports Camp is an in-depth sports program committed to developing fundamental skills. In addition, all campers participate in many age appropriate games designed to enhance their skills and knowledge of each sport. Field trip included.
General Camp Fees
Pre-care: 8 - 9 am Post-care 4 - 5 pm
5 Day Fee: $375 | Member: $300 Daily Fee: $80 | Member: $65 Day-of Rate: $90 | Member $75
Pre & Post-care
TO REGISTER, EMAIL APPLICATION TO: camp@mbjcc.org
Sports Camp
Pre-care Daily Fee: $5 Post-care Daily Fee: $5 No refunds or credits for missed days. Cancellations required 24 hours in advance for a refund.
5 Day Fee: $425 | Member $350 Daily Fee: $90 | Member $75 Day-of Rate: $100 | Member $85
FOR MORE INFORMATION: JENNY MERMELSZTEYN Director of Camping & Children/Family Programs jenny@mbjcc.org | x210
4221 Pine Tree Drive, Miami Beach FL 33140 |
(305) 534-3206 |
mbjcc.org
SPRING BREAK CAMP 2020 Registration Form MEMBER*: Yes
REGISTRATION DATE:________________________________
No
TO REGISTER EMAIL APPLICATION TO: camp@mbjcc.org
PARTICIPANTS INFORMATION Full Name ________________________________________________
Birthday (Mo/Day/Yr) ___/___/___
Gender___________
School _________________________________________
Grade ______________________
Age ______________
Allergies ____________________________________________________________________________________________________ FAMILY INFORMATION Address__________________________________________________
City, State, Zip ______________________________________
Home Phone ________________________________
Cell ________________________________________________
PARENT/GUARDIAN 1 Full Name ___________________________________
Email _____________________________________________
Work Phone ___________________________________
Cell ________________________________________________
PARENT/GUARDIAN 2 Full Name ______________________________________
Email _____________________________________________
Work Phone _____________________________________
Cell ________________________________________________
EMERGENCY & PICKUP AUTHORIZATION CONTACTS
Please provide three additional people who have authority to make all decisions regarding your child(ren) if we are unable to reach a parent/guardian as well as a list of people who are authorized to pick up your child(ren) from the MBJCC. In the event of an emergency, we will attempt to contact a parent/ guardian first. Please notify the MBJCC of any pick-up changes for the day if applicable. Please note proper identification will be required for anyone picking up your child(ren).
EMERGENCY PICKUP
Full Name _________________________________________
Relation ___________________________
Work Phone __________________________________________
Cell _______________________________
Full Name ____________________________________________
Relation ___________________________
Work Phone __________________________________________
Cell _______________________________
Full Name ____________________________________________
Relation ___________________________
Work Phone __________________________________________
Cell _______________________________
CAMP SELECTION General
Sports
DAYS March 23
March 24
Pre-care | Post-care
Pre-care | Post-care
March 25
Pre-care | Post-care
March 26
Pre-care | Post-care
March 27
Pre-care | Post-care
PAYMENT Payment Type:
(Payable to MBJCC)
Credit Card on File
Name on Card _________________________________________
Credit Card # __________________________________________
CVV # ____________
Authorized Signature ___________________________________
Exp. Date _________________
WAIVER DISCIPLINE & CHILD BEHAVIOR: The MBJCC should be made aware in writing of any special needs or limitations a child may have. In the event our staff sees your child is having difficulty with the structure that we provide, we will notify you and discuss the implementation of behavior modification programs with staff and your child. After implementing behavioral programs, if your child continues to experience difficulty, we will recommend other appropriate alternatives. HEALTH AND SAFETY: The Parent or Guardian certifies that the child is healthy and able to participate in all Spring Camp activities at the time of application. Updated school health forms are required prior to the start of the program. Parent/guardian gives permission to secure proper medical treatment in case of an emergency, when parent/guardian can not be reached. FIELD TRIPS AND ACTIVITIES: Permission is hereby granted for the child to participate in all field trips and activities. The MBJCC has the right to change the dates and locations of field trips as necessary. PUBLICITY: The MBJCC reserves the right to use photographs and/or videos of my child for publicity purposes in all media including the MBJCC website and all social media.
Parent/Guardian Signature ______________________________________________________
Date _________________
4221 Pine Tree Drive, Miami Beach FL 33140 | (305) 534-3206 | mbjcc.org