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	Online Registration Form

Refund policy for seasonal camps: As of 1/5/13, all seasonal camp fees paid at the time of enrollment are

non-refundable.  Seasonal Camp fees can however be transferred to another JCC program.

APJCC Camp Online Registration

Please fully complete this form. Incomplete forms will be returned with deposit, and spaces will not be guaranteed until forms are returned with complete information.

Note: To submit your camp deposit using this online form, you must already have a credit card on file with the JCC. If you do not have a credit card on file with us, please print out the camp registration and then mail it or fax it to the JCC.

* Membership:	I am an APJCC member. My membership number is... Note: Your membership number is the number on your membership card that begins with the letter J.  I am a non-member.  JCC Staff
* Parent/Guardian(1):
* Home Phone:
Cell Phone:
Work Phone:
* Address Line 1:
Address Line 2:
* City:
* State:	California Alabama Alaska Arizona Arkansas 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Zip:
* Email:
Parent/Guardian(2):
Home Phone:
Cell Phone:
Work Phone:
Address Line 1:
Address Line 2:
City:
State:	California Alabama Alaska Arizona Arkansas 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Email:
* Camper Name (1):
* Child's Birth Date:
* Child's Gender:	Male     Female
* Grade in School:	(as of Sept 2013)
School Name:
	Camp Choices You can use this form to register for up to four camps.
#1	* Camp Name: *Session, or camp dates: * Year: * Do you want to sign up for Extended Care? (specify AM, PM, Both, or None) * T-Shirt Size (specify children's size 2-4, 6-8, 8-10, 10-12, or adult size S, M, L or XL): * Fee:
#2	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size: (specify children's size 2-4, 6-8, 8-10, 10-12, or adult size S, M, L or XL) Fee:
#3	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify schildren's size 2-4, 6-8, 8-10, 10-12, or adult size S, M, L or XL): Fee:
#4	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify size children's size 2-4, 6-8, 8-10, 10-12, or adult size S, M, L or XL): Fee:
Camper Name (2):
Child's Birth Date:
Child's Gender:	Male     Female
Grade in School:	(as of Sept 2013)
School Name:
	Camp Choices You can use this form to register for up to four camps.
#1	Camp Name: Session, or camp dates: Do you want to sign up for Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#2	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify size children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#3	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify size children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#4	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify size children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
Camper Name (3):
Child's Birth Date:
Child's Gender:	Male     Female
Grade in School:	(as of Sept 2013)
School Name:
	Camp Choices You can use this form to register for up to four camps.
#1	Camp Name: Session, or camp dates: Do you want to sign up for Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#2	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#3	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
#4	Camp Name: Session, or camp dates: Extended Care? (specify AM, PM, Both, or None) T-Shirt Size (specify children's size 2-4, 6-8, 8-10, or 10-12, or adult size S, M, L or XL): Fee:
* Deposit (required deposit is $200 per child for Camp Pashoshim or Camp Katan, or $150 per child for all other camps):	$
* Balance due less deposit:	$
* Permission:	I hereby grant permission for camper to participate in the swim instruction at the APJCC (if swimming is included in their camp curriculum). I hereby grant permission for my camper to participate in field trips or specialties away from the APJCC (if field trips or specialties are included in their camp curriculum). I give permission to the APJCC to authorize any emergency action necessary to ensure the safety of my child. I understand that the APJCC is not financially responsible for medical or emergency care given to my child. I accept all financial responsibility for 100% of camp fees. I have enclosed a nonrefundable, nontransferable deposit per session (see fees and deposits) and understand that the balance of payment is due no later than June 7, 2013.
* Payment Info:	I am a JCC member and you have my credit card on file. You have my permission to charge my credit card.

* = required field

Withdrawal deadline: June 7, 2013
Final Payment deadline: June 7, 2013

Deposit Policy and Refund Policy: Deposits are due upon registration. Deposits are nonrefundable and nontransferable to other APJCC programs and services outside of camp. Balances for all camp programs regardless of session must be paid in full by June 7th, 2013 in order to complete enrollment. The APJCC will not guarantee placement if balances are outstanding after that date. Refunds of camp fees for any session will be granted, less deposit, only if the APJCC is notified in writing of withdrawal prior to June 7th, 2013. Notification of withdrawal after June 7th, 2013 will result in a LOSS OF ALL FEES PAID.

Payment Information...

• If you are a Center Member and pay for your membership through automatic billing of your credit card each month, you have the option of paying online by selecting the "Charge my credit card on file" box above. If the JCC has your credit card on file for any other reason, you can also pay online. Make sure you've selected the "Charge my credit card on file" box above, and then press the "Submit Form" button below.
  
  

• If the JCC does not have your credit card on file, or if you would prefer to mail your payment, click the "Print Form" button to print this form. Then mail it with your check made payable to “APJCC”. You can also deliver your check and completed form to the JCC Service Desk. If you would prefer to pay by credit card, click here to print an application form that includes a section for your credit card information.
  
  
  
  
  
  Mailing address:
  Addison-Penzak Jewish Community Center, Attn: Summer Camp
  14855 Oka Road, Suite 201
  Los Gatos, CA 95032
  
  Questions about camp?
  Call the JCC Camp Office at 408.357.7447 or email camp@svjcc.org.