Kiddie Korner 2018 Camp Registration

$50 registration fee via PayPal required. You will be directed there upon completion of this form. Please call (718) 596-4840 x 10 for assistance.

Please Select Which Session/s: click here for more info

June 25 - July 6

July 9 - July 20

July 23 - August 10

Please Select Which Program:

Note: If your child is 4 or 5 years old, you can only choose the full day schedule because of the special trips and programs included in their day.

All 5 Days (of the week)?

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


Child's School Year of Entry:

Child's Name*:

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

DOB (MM/DD/YYYY format)*:

Gender:

Home Address*:

ZIP*:

Home Phone*:

Cell Phone:

Child Lives With*:

Child's Age by September 2018: Years Months


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*:


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*:


Previous/Current School or Playgroup*:

May we have permission to contact them?

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 Become Interested In Our Camp?


Do you consent to allow your child to participate in supervised curricular and extracurricular activities that may include leaving the building?

Signature of Parent*: 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.


Would you like to receive emails about our future programs in the Preschool and Synaguouge?

Prior to submission, you will be directed to PayPal to pay the $50 registration fee.