Camp Xtreme!

Date: June 21st - Aug 5th

Time: 9:00am-3:30pm M-T and 9:00am-2:00pm on Friday

Ages: Boys 4th grade-7th grade

Cost: $375 per week, $2,500 for all 7 weeks

Busing will be available for $50 per week.

Camper Information

First Name*

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Last Name*

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Date of Birth*

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What School Does your Child Currently Attend?

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Please List Any Allergies your Child Has*

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Instructions in Case of Contact with Allergen*

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Please Indicate Any Medications Your Child is Taking*

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Doctor's Name*

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Doctor's Phone Number*

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Parent Information

First Name (Guardian 1)*

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Last Name*

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Street Address*

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City*

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Zip/Postal*

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Email Address*

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Phone Number*

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First Name (Guardian 2)

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Last Name

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Cell Phone

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Emergency Contact*

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Emergency Contact*

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Which weeks of camp is your camper attending?

Camp Costs $375 per week or $2500 for all 7 Weeks (Save $125)

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Week 1 June 21st- June 24th

Week 2 June 27th- July 1st

Week 3 July 5th- July 8th

Week 4 July 11th- July 15th

Week 5 July 18th- July 22nd

Week 6 July 25th- July 29th

Week 7 Aug 1st- Aug 5th

All 7 Weeks! (Save $125)

Please click box below to agree to the $75 registration fee*

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$75.00 - Registration Fee

What is your child's t-shirt size?*

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This summer we are excited to offer Bus transportation from the Pico area for an additional price of $50 per week.

The Buses load from 8:15 AM to 8:35 AM and return approximately 4:00 PM. Each Bus will have bus monitors, ensuring our campers utmost safety on board, as well as to check campers in and out in the morning and afternoon.

Please let us know if you will be taking the bus?*

Answer Required

I authorize all medical and surgical treatment and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency. *

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I consent

I do not consent

I give permission for my child to go on field trips. I release Camp Yavneh and individuals from liability in case of accident during activities related to Camp Yavneh, as long as normal safety procedures have been taken. *

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I consent

I do not consent

Enrollment in camp is a grant and authorization to use the child's photographs, recordings, likeness, achievements, and artwork in promotional publications, including the school's website and other online and offline media.

Please fix the highlighted areas below before submitting.

Camp Xtreme!

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