Summer Camp Enrollment Form 2026

Camper information

How many Campers are you registering?*

Camper 1

Full Name*

First Name Last Name

Date of Birth*

Month Day Year

Age*

Grade currently in*

Camper 2

Full Name*

First Name Last Name

Date of Birth*

Month Day Year

Age*

Grade currently in*

Camper 3

Full Name*

First Name Last Name

Date of Birth*

Month Day Year

Age*

Grade currently in*

Parent Information

Father's Name*

First Name Last Name

Phone Number*

E-mail*

Mother's Name*

First Name Last Name

Phone Number*

E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact

Emergency Contact*

First Name Last Name

Relationship to child*

Phone Number*

Other Person Authorized to Pick-up Child

Full Name*

First Name Last Name

Relationship to child*

Phone Number*

Accident, Field Trip and Privacy Declaration

Accident

As the parent(s) or legal guardian of my/our child, I/we authorize any adult acting on behalf of Aleph ELC to hospitalize or secure treatment for my child; I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Aleph ELC personnel will try, but are not required to communicate with me prior to such treatment.

Agreement *

I Agree

Date*

Month Day Year

Trips & Outings

I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Aleph ELC.

Agreement *

I Agree

Date*

Month Day Year

Privacy

I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, Aleph ELC website and Aleph ELC social media. I understand that I can withdraw my consent at any time.

Agreement *

I Agree

Date*

Month Day Year

Payment Information
Registration is confirmed with a $50 deposit per child, charged immediately upon submission of this form. This deposit is applied toward tuition.

Monthly Tuition
Tuition is billed at $1,650 per child per month.

Agreement *

I Agree

Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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