Registration Form
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Camper(s)

Name_____________________________________________

School_____________________________________________

Grade_____________________________________________

Age_________M/F_________

Name_____________________________________________

School _______________________________________

Grade_______________________________________

Age_________M/F_________

Parent(s)

Name(s)________________________________________

Phone#________________________________________

Address_______________________________________

City__________________________________________

State______Zip_________________________________

[  ] I UNDERSTAND THAT THE DEPOSIT AND BALANCE PAID ARE BOTH NON-REFUNDABLE.

[  ] PLEASE SEND ME AN APPLICATION TO REGISTER MY CHILD/CHILDREN FOR THE 2017 SUMMER SESSION.

[  ] A $50.00 deposit/processing fee per child is enclosed with this form. I understand that, upon receipt of this deposit, Mishkan Israel Day Camp will mail me registration and medical forms along with information.

[  ] I HEREBY FULLY AGREE TO ALL FINANCIAL OBLIGATIONS AND RESPONSIBILITIES. AS PER CAMP POLICY: NO MEDICATIONS WHATSOEVER ARE DISPENSED AT CAMP.

[  ] Please make checks payable to "Mishkan Israel Day Camp" and mail to:

Mishkan Israel Day Camp
P.O. Box 11196
Greenwich, CT 06831

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