Winter Camp Registration 2022 Winter Camp this year will be held from Tuesday, December 27th hru Thursday December 29th 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 Name First Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Parents E-mail Camper Allergies Tshirt Size Child Medium Child Large Adult Small Adult Medium Adult Large Adult X-Large Parent'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? Tuesday, December 27th Wednesday, December 28th Thursday, December 29th I 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. Yes Does your child need to ride in a car seat? Yes, I will provide it No By 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 Winter 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. Yes I 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 $1800.00 Total $0.00 Payment Credit Card Paypal Scholarship Request/Pay By Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Expiration Year Paypal 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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