2025 Kamp Kol Emet - Form - Congregation Kol Emet

Kamp Kol Emet 2025
June 23-August 22, 2025
9:00am-1:00pm or 9:00am-3:00pm

* Is your family new to Kamp Kol Emet?

Please Select OneNoYes

Section A: Family Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Kamper

* Street Address (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, but at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Section B: Kamper Enrollment Information

* How many kampers will you be enrolling for Summer 2025

1 Child2 Children3 Children

Kamper 1 Information

* Kamper 1 Last Name

* Kamper 1 First Name

Kamper 1 Pronouns

HeSheThey

* Kamper 1 Birthdate

Kamper 1 Nickname (if applicable)

* Kamper 1 Half Day or Full Day

* Kamper 1 Special Learning/Participation Needs

Please Select OneNoYes (IEP or 504)If yes, Sue Weiner would love to sit down with you before camp begins so that we are able to discuss the best ways to support your child from day one. If you are comfortable, we invite you to send any documentation ahead of time to suew@kolemet.org

* Kamper 1 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Kamper 2 Information

* Kamper 2 Last Name

* Kamper 2 First Name

Kamper 2 Pronouns

HeSheThey

* Kamper 2 Birthdate

Kamper 2 Nickname (if applicable)

* Kamper 2 Half Day or Full Day

* Kamper 2 Special Learning/Participation Needs

* Kamper 2 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Kamper 3 Information

* Kamper 3 Last Name

* Kamper 3 First Name

Kamper 3 Pronouns

HeSheThey

* Kamper 3 Birthdate

Kamper 3 Nickname (if applicable)

* Kamper 3 Half Day or Full Day

* Kamper 3 Special Learning/Participation Needs

* Kamper 3 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Payment Information

Deposit

A $225 deposit is required for each Kamper.
I understand my financial obligation and agree to the tuition rate for my choices above. An invoice will be sent with your balance and kamper forms when the registration is received. All payments are due by June 1, 2025. The deposit, less $25 registration fee, is refundable

Section C: Release Forms

By signing my name below, my child(ren) have permission to participate in Kamp Kol Emet programs. In the case of an injury, you allow Kol Emet to treat your child(ren) for the injury, and to contact the primary parent listed, and emergency services if needed.

* Medical Release: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Media Release

Media Release Approval (Please select all that apply)

Child/ren's image permitted on FacebookChild/ren's image permitted on Kol Emet WebsiteChild/ren's image permitted on Daily Emails to Kamp Families OnlyNo images of my child/ren may be useFrom time to time your child’s photo may be taken while engaging in Kamp activities. We use these photos in the synagogue newsletters, on our synagogue website as well as our Facebook groups and other publicity materials. No names are ever published.