Printed from ChabadRGV.com

Registration Form 2017

Registration Form 2017

 

 

Camper Information

  Kids In Action Summer Program Registration Form

Last Name

 

First Name

 

Hebrew Name

 

Gender

 

Date of Birth

 

Grade

 

Shirt Size

 

Carpool / Transportation

Request
(additional fees may apply)

 

Sessions

 

 

 

 

Parent Information

 

 

Father

 

 

Title

 

First Name

 

Last Name

 

Work Phone

 

Cell Phone

 

Email

 

 

 

 

Mother

 

 

Title

 

First Name

 

Last Name

 

Work Phone

 

Cell Phone

 

Email

 

 

 

 

Emergency Information

 

 

Emergency 1

 

Emergency 2

 

 

I Will Fill Out And Send In The Medical Form Click Here For PDF Medical Form

   

 

Payment Information

   

 

 

 

 

Session 1 / $300 Tuition Fee / Per Week

 

 

Session 2 / $200 Tuition Fee / Per Week

 

 

One Day / $60 Tuition Fee / Per Day/ Qty

 

Card Type

 

Card Number

 

Expiration Date

 

Security Code

 

Name on Card

 

Billing Address

 

Billing Postal Code

 

 

 

 

Terms and Conditions

   
  1. TUITION FEES & REFUND POLICY: Tuition fees are $200/$300 per session or $500 for both sessions. All payments are non-transferable to other parties and not exchangeable for other weeks. Registration is per week, no prorating per day. The $25 registration fee is due upon registration and is non-refundable. The weekly tuition fees are due by July 15th and are fully refundable until July 20th. After July 20th, there will be no refunds granted.
  2. EMERGENCY CARE: I have filled out and will send in the medical form. In the event of an emergency, serious illness, or accident, KIA Mcallen has my permission to arrange for necessary first-aid or care by a licensed physician for my child(ren) while he/she is attending camp.
  3. IMAGES:  KIA Mcallen is hereby granted permission to use any individual or group camp photos and or videos showing our child(ren) involved in camp activities.
  4. DAMAGES: As parents or guardians, we agree to be responsible for any loss, damage or destruction by our child to any property of KIA Mcallen or to any property for which the camp is liable or chargeable.
  5. SIGNATURE & AGREEMENT: I give my child(ren) permission to participate in all KIA Mcallen activities, including but not limited to swimming, water-front activities and group field trips, unless specified in written notice to the camp by me.

    I here by agree to all the above including the registration fee required and my name typed in below acts as my signature in full agrrement

    Full Name

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