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Camp Registration Form
CAMP KULANU AT RPRY – June 26 – August 16, 2018*
(18 month – 3rd Grade)

We are delighted to present the CAMP KULANU SPECIAL RATES. Please use this form to register your child(ren). Our new online registration site is currently under construction and will be available soon! If you have any questions please contact rprydaycamp15@gmail.com or call (732) 572-5052.

Lower Division: 18 months - Kindergarten (5 by 12/31/2018)
Upper Division: Entering Grades 1-3

*No Camp on July 4, 2018.

Hours: 9:00 a.m.-4:00 p.m.

Full & Half day (Lower Division only) weekly and daily rates are available. Please Check appropriate box below and (732) 572-5052 or nwwilliams@rpry.org, for more information.

Please see payment instructions at the bottom of the form.

Please submit completed Health & Medical Forms online, by clicking on the Health Forms links at www.rpry.org/camp-kulanu/index, including all necessary downloaded forms. Please note that ALL MEDICAL FORMS MUST BE SUBMITTED BY JUNE 14, 2018. NO CHILD WILL BE ADMITTED TO CAMP, WITHOUT COMPLETED, SIGNED HEALTH FORMS. Thank you!

Camper Information:
Please fill out all the information below
Choose Which Applies: *
Required
Camper 1 Name: *
Your answer
Date of Birth *
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DD
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YYYY
Gender *
Age as of 12/31/18 *
Your answer
School Attending *
Your answer
Grade in Sept. 2018 *
Your answer
Camper 2 Name:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Age as of 12/31/1
Your answer
School Attending
Your answer
Grade in Sept. 2018
Your answer
Camper 3 Name:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Age as of 12/31/18
Your answer
School Attending
Your answer
Grade in Sept. 2018
Your answer
Camper 4 Name:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Age as of 12/31/1
Your answer
School Attending
Your answer
Grade in Sept. 2018
Your answer
Home Address *
Your answer
Parent/Guardian 1 - Primary *
Your answer
Full Name *
Your answer
Primary Phone # *
Your answer
Alternate Phone #
Your answer
Primary Email *
Your answer
Parent/Guardian 2 - Secondary *
Your answer
Full Name *
Your answer
Primary Phone # *
Your answer
Alternate Phone #
Your answer
Secondary Email *
Your answer
Please fill in 3 names of bunkmates for each camper to guarantee that at least one of the 3 listed will be in your child's bunk: *
Your answer
How did you find out about Camp Kulanu at RPRY? *
Your answer
Payment Instructions:
Please submit your check made out to RPRY by May 28, 2018. Please add "Camp Kulanu at RPRY” in the notes section.

Please note that NO REFUNDS WILL BE GIVEN, after Registration is submitted.

Health & Medical Forms
Please submit completed Health & Medical Forms online by clicking on the Health & Medical Form link on the RPRY website, Camp Kulanu section (at www.rpry.org/camp-kulanu/index). First download the required documents (Physical Evaluation Form and Authorization for Medical Treatment Form) from the website - Camp page; complete the forms and then complete the Health & Medical Form by filling in all information and uploading both required documents. Please note that ALL HEALTH & MEDICAL FORMS MUST BE SUBMITTED BY JUNE 14, 2018. Due to NJ State compliance requirements, NO CHILD WILL BE ADMITTED TO CAMP, WITHOUT COMPLETED & SIGNED HEALTH & MEDICAL FORMS. Thank you.
Photo & Video Policy
Please note that Camp Kulanu at RPRY routinely takes group photographs and videos of various activities and campers, counselors, staff, parents and other attendees, which may include your child(ren). Camp Kulanu may use these photographs and videos for Camp use and for promotion of the Camp. If you do not want your child's picture or video taken ALONE (ie, a photo or video of just your child), please indicate as such in the Photo & Video Policy portion of the Health & Medical Form, linked from the RPRY website, Camp page. Thank you.
Thank you for registering and we can't wait to see your children for a fabulous summer of Camp Kulanu at RPRY!
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