Test Page – Congregation B'nai Israel

Camp B'nai Ruach Registration 2023

"*" indicates required fields

Number of children you are registering:*

One

Two

Three

Four

Camper 1 - Name*

First Last

Child 1 - Date of Birth*

Child 1 - Grade in September 2023*

Child 1 - Gender*

Child 1 - T-shirt Size (Included in camp fees)*

Extra T-shirt Camper 1

Price: $15.00

Camper 2 - Name*

First Last

Child 2 - Date of Birth*

Child 2 - Grade in September 2023*

Child 2 - Gender*

Child 2 - T-shirt Size (Included in camp fees)*

Extra T-shirt Camper 2

Price: $15.00

Camper 3 - Name*

First Last

Child 3 - Date of Birth*

Child 3 - Grade in September 2023*

Child 3 - Gender*

Child 3 - T-shirt Size (Included in camp fees)*

Extra T-shirt Camper 3

Price: $15.00

Camper 4 - Name*

First Last

Child 4 - Date of Birth*

Child 4 - Grade in September 2023*

Child 4 - Gender*

Child 4 - T-shirt Size (Included in camp fees)*

Extra T-shirt Camper 4

Price: $15.00

Is there anything you would like to mention about your children to ensure your camper has a wonderful time at camp?

Parent/Guardian 1 - Name*

First Last

Parent/Guardian 1 - Address*

Street Address City State ZIP Code

Parent/Guardian 1 - Cell Phone*

Parent/Guardian 1 - Email*

Parent/Guardian 2 - Name

First Last

Parent/Guardian 2 - Address

Street Address City State ZIP Code

Parent/Guardian 2 - Cell Phone

Parent/Guardian 2 - Email

Are you a member of Congregation B'nai Israel?*

Do you want to add Extended Care to your child(ren)'s camp day?*

CAMP HOURS & EXTENDED CARE
Camp hours are 9:00 am - 4:00 pm daily. Extended care is offered from 8:00 am - 9:00 am and 4:00 pm - 6:00 pm. EC weekly rates include morning and afternoon care and can be added to camp tuition discounted at $130 a week. Daily rate is $20 per hour/per child. If your child arrives prior to 9 am or is picked up after 4 pm, you will be billed for extended hours.

Camp Pricing Summer 2023
Camp Weeks 1,3,4,5 - CBI Member $350/Non-member $375
Camp Week 2 - CBI Member $300/Non-member $320
Super Early Bird Special - register by April 15 and receive $50 off registration fee - Enter Coupon code SUPER2023
Early Bird Special - register by May 1 and receive $30 off registration fee - Enter Coupon code EARLYBIRD

Registration Fee*

Price: $0.00

Weeks your campers are attending camp:*

Camp Week 1 (6/26-6/30)

Camp Week 2 (7/3-7/7)

Camp Week 3 (7/10-7/14)

Camp Week 4 (7/17-7/21)

Camp Week 5(7/24-7/28)

Week 1 - Member - No EC (Add # of campers attending this week)

Price: $350.00

Week 1 - Member - EC (Add # of campers attending this week)

Price: $480.00

Week 1 - Non Member - No EC (Add # of campers attending this week)

Price: $375.00

Week 1 - Non Member - EC (Add # of campers attending this week)

Price: $505.00

Name of Campers Attending Week 1

Week 2 - Member - No EC (Add # of campers attending this week)

Price: $300.00

Week 2 - Member - EC (Add # of campers attending this week)

Price: $430.00

Week 2 - Non Member - No EC (Add # of campers attending this week)

Price: $320.00

Week 2 - Non Member - EC (Add # of campers attending this week)

Price: $450.00

Name of Campers Attending Week 2

Week 3 - Member - No EC (Add # of campers attending this week)

Price: $350.00

Week 3 - Member - EC (Add # of campers attending this week)

Price: $480.00

Week 3 - Non Member - No EC (Add # of campers attending this week)

Price: $375.00

Week 3 - Non Member - EC (Add # of campers attending this week)

Price: $505.00

Name of Campers Attending Week 3

Week 4 - Member - No EC (Add # of campers attending this week)

Price: $350.00

Week 4 - Member - EC (Add # of campers attending this week)

Price: $480.00

Week 4 - Non Member - No EC (Add # of campers attending this week)

Price: $375.00

Week 4 - Non Member - EC (Add # of campers attending this week)

Price: $505.00

Name of Campers Attending Week 4

Week 5 - Member - No EC (Add # of campers attending this week)

Price: $350.00

Week 5 - Member - EC (Add # of campers attending this week)

Price: $480.00

Week 5 - Non Member - No EC (Add # of campers attending this week)

Price: $375.00

Week 5 - Non Member - EC (Add # of campers attending this week)

Price: $505.00

Name of Campers Attending Week 5

Medical Release/Permission Slip

Camper's Pediatrician Name*

Camper's Pediatrician Phone*

Medical Insurance Carrier*

Policy #*

Emergency Contact Name*

Emergency Contact Phone*

Camper 1 Name*

Camper 1 Health/Dietary/Restrictions*

Camper 1 Allergies*

Camper 1 Medications*

Camper 2 Name*

Camper 2 Health/Dietary/Restrictions*

Camper 2 Allergies*

Camper 2 Medications*

Camper 3 Name*

Camper 3 Health/Dietary/Restrictions*

Camper 3 Allergies*

Camper 3 Medications*

Camper 4 Name*

Camper 4 Health/Dietary/Restrictions*

Camper 4 Allergies*

Camper 4 Medications*

Parent Signature*

Date*

Payment Information

Payment Method*

I will send a check to the CBI office

Credit Card (Visa or MasterCard)

Payment Plan - 4 Equal Payments (Available until March 16 for weeks 1&2 and April 1 for weeks 3-5).

No exceptions will be made. No refunds after June 22, 2023. Add-ons Always welcome!
Questions? Please contact Camp Director - Sheri Galante (310)918-3702 camp@cbi18.org

CHECK PAYMENT
Please make checks payable to: CBI Camp B’nai Ruach
Mail payments to: 2111 Bryan Avenue, Tustin, CA 92782

Coupon codes (Apply one at a time)
By April 15 - Super Early Bird Special $50 off - Coupon code SUPER2023
By May 1 - Early Bird Special $30 off - Coupon code EARLYBIRD
To confirm 4 monthly Payments - Coupon code PAYMONTHLY (expired April 1)

Coupon code

Total

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name