Summer Camp Registration 2022Summer Camp this year will be held from Monday, June 13th to Wednesday, June 15th at 22044 North 44th Street.Drop off will be at 10:00AM and pick up will be at 3:00PM!Cost: $75 per day (Scholarships are available) We will be having a variety of activities, games, sports, field trips and more!We can't wait to have your camper join us for days of fun! If you have never filled out a Friendship Circle intake form, you will be directed to our online intake form after we process your registration.Camper's Full NameFirst NameLast NameBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearParents E-mailCamper AllergiesTshirt SizeChild MediumChild LargeAdult SmallAdult MediumAdult LargeAdult X-LargeParent's Emergency Contact Information(Please enter both Mom & Dad and cell phones for each)Second Emergency Contact Information(Name, Relationship and Phone #)Does your Child have any restrictions for activities that we should be aware of?Anything we should know to make your campers experience the best it can be?How many days will your camper be attending Summer Camp?Monday, June 13thTuesday, June 14thWednesday, June 15thI give permission to the Friendship Circle of Arizona and its professional staff members to transport my camper to and from Field Trips using methods of transportation such as rented vans and school busses.YesDoes your child need to ride in a car seat?Yes, I will provide itNoBy clicking "yes", I allow my child to participate in all outings and activities and agree to release Friendship Circle of Arizona, its providers and administrators, from all liability for any incident which may affect the health, welfare or safety of my child during Summer Camp 2022. I hereby give permission to the Friendship Circle of Arizona to seek medical treatment for my child in the event that my child has an emergency and the emergency contacts listed above cannot be reached.YesI would like to make an optional donation to help sponsor a child in camp:$0.00$50.00$75.00$100.00$180.00$500.00$1000.00$1800.00Total$0.00PaymentCredit Card Paypal Scholarship Request/Pay By Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearPaypal has been selected. Payment will take place on the next page.Please reach out to Rabbi Mendy: [email protected] to request a scholarship. 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