Registration

Kiddie Korner 2026 Camp Registration

 A $100 registration fee and $10 camp t-shirt fee via PayPal required. You will be directed there upon completion of this form. Please call (718) 596-4840 for assistance.

 

Child's Name*:

Child's Hebrew Name: (If inapplicable type "N/A")

DOB (MM/DD/YYYY format)*:

Gender: Female Male

Home Address*:

ZIP*:

Home Phone*:

Cell Phone:

Child Lives With*:

Child's Age by September 2026: 6 5 4 3 2 1 0 Years 11 10 9 8 7 6 5 4 3 2 1 0 Months

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Father's Name*:

Father's Hebrew Name: (If inapplicable type "N/A")

Home Address (If Different From Above):

Cell Phone*:

Occupation:

Position/Title:

Work Phone:

Work/Business Address:

Email*:

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Mother's Name*:

Mother's Hebrew Name: (If inapplicable type "N/A")

Home Address (If Different From Above):

Cell Phone*:

Occupation:

Position/Title:

Work Phone:

Work/Business Address:

Email*:

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Previous/Current School or Playgroup*:

May we have permission to contact them? Yes No

Contact Number*:

Language/s Spoken At Home:

Language/s Spoken By Child:

Name/s, Birthday/s, and School/s of Sibling/s:

Type Special Considerations, If Any:

How Did You Hear About Kiddie Korner Day Camp?

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 Please Select Which Session/s: click here for price schedule

June 29 - July 10 (2 week session)

July 13 - July 24 (2 week session)

July 27- August 14 (3 week session)

All 3 sessions 

Please Select Which Program:   9:00am - 12:00pm - Half Day 9:00am - 3:00pm - Full Day Other - only select if confirmed with office

Note: We do not offer the half day program (9am - 12pm) option for children that are 4 or 5 years old, due to their schedules including special trips and programs. If you would like to register for our 8am - 6pm schedule, please reach out to the office.

All 5 Days (of the week)?   No   Yes  

If Only 3 Days, Please Specify Which (M, T, W, TH, F format): 

T-shirt size:  Small Medium Large

Number of t-shirts (please note: ordering more than one t-shirt is only possible if you are registering at least two weeks in advance of camp): 

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Do you consent to allow your child to participate in supervised curricular and extracurricular activities that may include leaving the building? Yes No

By typing your name, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Form. 

Signature of Parent*:  

Would you like to receive emails about our future programs in the Preschool and Synagogue? Yes No

Prior to submission, you will be directed to PayPal to pay the $100 registration fee and $10 camp t-shirt fee.