MBJCC Spring Break Camp 2019

DON’T GET STUCK AT HOME

SPRING BREAK CAMP Monday, March 25 – Friday, March 29

Campers will enjoy all their favorite on-campus activities including sports, swimming, crafts, cooking, field trips as well as on-campus entertainment and more!

Campers will swim daily, please bring a swimsuit, towel, flip flops and sunscreen.

9 am - 4 pm Pre-care: 8 - 9 am Post-care 4 - 5 pm

General Camp Fees

5 Day Fee: $375 | Member: $300 Daily Fee: $80 | Member: $65 Day-of Rate: $90 | Member $75

Sports Camp

5 Day Fee: $425 | Member $350 Day-of Rate: $90 | Member $75 Day-of Rate: $100 | Member $85

Pre & Post-care

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.

TO REGISTER, EMAIL APPLICATION TO: camp@mbjcc.org

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 2019 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 25

March 26

Pre-care | Post-care

Pre-care | Post-care

March 27

Pre-care | Post-care

March 28

Pre-care | Post-care

March 29

Pre-care | Post-care

PAYMENT Payment Type:

(Payable to MBJCC)

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