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CA Camps
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GECC Summer Camp Application 2023
Please verify reCaptcha before submitting the form.
Child's Information
*
Child First Name
*
Child Last Name
*
Child Date of Birth
*
Gender
Camp Registration
*
Please check which size camp t-shirt you would like your child to receive (no additional charge). All registrations must be in by May 1st in order to receive the shirt!
Please Select One
XS
S
M
L
XL
*
Please Select the Camp Program you would like to enroll your child in:
Please Select One
2s Camp Program 9am-12:30pm
2s Camp Program 9am-3pm - waitlisted
3s Camp Program 9am-1pm
3s Camp Program 9am-3pm
*
2s Camp Program - 9am-12:30pm
Please Select One
M/W/F
3 days
5 days
Monday, Wednesday, Friday or 3 days - $165/week
5 days - $260/week.
*
# of weeks signing up for
Please Select One
3 Weeks
4 Weeks
5 Weeks
6 Weeks
7 Weeks
Discount if you sign up for multiple weeks:
4 weeks - $250/week, 5 weeks - $245/week, 6 weeks - $240/week, 7 weeks - $235/week
*
Please indicate which weeks you would like to register for:
Week 1 June 26 - June 30
Week 2 July 3 - July 7 – (no camp on July 4th)
Week 3 July 10 - July 14
Week 4 July 17 – July 21
Week 5 July 24 - July 28
Week 6 July 31- August 4
Week 7 August 7-August 11 (12:00 dismissal)
*
2s Camp Program - 9am- 3pm - waitlisted
Please Select One
M/W/F
3 days
5 days
Monday, Wednesday, Friday or 3 days - $260/week
5 days - $430/week.
*
# of weeks signing up for
Please Select One
3 Weeks
4 Weeks
5 Weeks
6 Weeks
7 Weeks
Discount if you sign up for multiple weeks:
4 weeks - $420/week, 5 weeks - $415/week, 6 weeks - $410/week, 7 weeks - $405/week
*
Please indicate which weeks you would like to register for:
Week 1 June 26 - June 30
Week 2 July 3 - July 7 – (no camp on July 4th)
Week 3 July 10 - July 14
Week 4 July 17 – July 21
Week 5 July 24 - July 28
Week 6 July 31- August 4
Week 7 August 7-August 11 (12:00 dismissal)
*
3s Camp Program 9am-1pm
Please Select One
M/W/F
3 days
5 days
Monday, Wednesday, Friday or 3 days - $195/week
5 days - $270/week
*spots are limited
*
# of weeks signing up for
Please Select One
3 Weeks
4 Weeks
5 Weeks
6 Weeks
7 Weeks
Discount if you sign up for multiple weeks:
4 weeks - $260/week, 5 weeks - $255/week, 6 weeks - $250/week, 7 weeks - $245/week
*
Please indicate which weeks you would like to register for:
Week 1 June 26 - June 30
Week 2 July 3 - July 7 – (no camp on July 4th)
Week 3 July 10 - July 14
Week 4 July 17 – July 21
Week 5 July 24 - July 28
Week 6 July 31- August 4
Week 7 August 7-August 11 (12:00 dismissal)
*
3s Camp Program 9am-3pm
Please Select One
M/W/F
3 days
5 days
Monday, Wednesday, Friday or 3 days - $260/week
5 days - $375/week
*spots are limited
*
# of weeks signing up for
Please Select One
3 Weeks
4 Weeks
5 Weeks
6 Weeks
7 Weeks
Discount if you sign up for multiple weeks:
4 weeks - $365/week, 5 weeks - $360/week, 6 weeks - $355/week, 7 weeks - $350/week
*
Please indicate which weeks you would like to register for:
Week 1 June 26 - June 30
Week 2 July 3 - July 7 – (no camp on July 4th)
Week 3 July 10 - July 14
Week 4 July 17 – July 21
Week 5 July 24 - July 28
Week 6 July 31- August 4
Week 7 August 7-August 11 (12:00 dismissal)
*
Does your Child Need Early Arrival beginning at 8am?
Please Select One
Yes
No
Early drop off will be available - $10 per day.
*
Early Arrival
Monday ($10)
Tuesday ($10)
Wednesday ($10)
Thursday ($10)
Friday ($10)
*
Does your Child Need Late Stay from 3pm-4pm?
Please Select One
Yes
No
Late stay will be available - $10 per day.
*
Late Stay
Monday ($10)
Tuesday ($10)
Wednesday ($10)
Thursday ($10)
Friday ($10)
*
Child's Allergy, Dietary, and Medical Information
Please Select One
No, Health Concerns
Yes
Allergy, Dietary, and Medical Information
Parent Information
Parent #1 Prefix
Please choose one
Mr.
Ms.
Mrs.
Dr.
*
Parent #1 First Name
*
Parent #1 Last Name
*
Parent #1 Cell Phone
Parent #1 Home Phone
Parent #1 Work Phone
*
Parent #1 E-mail address
This is also the email address at which you would like to be contacted.
*
Parent #1 Religion
*
Parent #1 Mailing Address
This is the primary mailing address for the student.
*
Parent #1 City
*
Parent #1 State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Parent #1 Zip
Marital Status
Please Select One
Single
Married, living together
Divorced, living apart
Seperated, living apart
Other
Please provide additional information:
Would you like to add a 2nd Parent
Please Select One
Yes
No
Parent #2 Prefix
Please choose one
Mr.
Ms.
Mrs.
Dr.
Parent #2 First Name
Parent #2 Last Name
Parent #2 Mailing Address
Parent #2 City
Parent #2 State
Parent #2 Zip
Parent #2 Cell Phone
Parent #2 Home Phone
Parent #2 Work Phone
Parent #2 E-mail address
*
Emergency Contact Name
Please enter an emergency contact in case we are unable to reach you directly.
*
Emergency Contact’s Relationship to Child
*
Emergency Contact’s Phone
*
Emergency Contact’s Email
Are you a member of Chizuk Amuno Congregation & Schools?
Yes
No
*
Do we have permission to use a photograph or video of your child in promotional materials?
Yes, I give permission for child(ren)’s image to be used as described above.
No, I do not give permission for child(ren)’s image to be used
My camper will have a sibling attending CA Camps this summer
Please Select
Yes
No
Sibling(s) Name(s):
Please enter any additional notes you’d like to provide to the Director.
*
Goldsmith Early Childhood Center requires all children to be fully vaccinated; we strongly encourage you to have your child COVID 19 vaccinated.
Yes, my child is fully vaccinated
No, my child does not have the COVID19 Vaccination
1st Dose
2nd Dose
3rd Dose
Camp Deposit/Application Fee - $150
Deposit is NON- REFUNDABLE AFTER MAY 1st.
This fee will be applied to your child's camp tuition total.
*
Camp Deposit/Application Fee today.
Please Select
GECC Camp - We acknowledge that we will be billed $150
Mon, May 12 2025 14 Iyyar 5785
. 