8511 Beverly Place • Los Angeles, CA 90048
•
310.659.2456
Monday, July 4, 2022
ה' תמוז תשפ"ב
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מי אנחנו
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Machane Maimo
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Machane Maimo Registration
Camper Information
Name
*
First
Last
Camper Birthdate
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
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11
12
13
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15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2023
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
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1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
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1978
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1971
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1967
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1964
1963
1962
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1958
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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
Gender
*
Male
Female
School
*
Grade entering Fall 2021
*
Pre-Nursery - A FEW SPOTS LEFT
Nursery - FULL
Kindergarten - FULL
Pre-1 - FULL
Grade 1 - A FEW SPOTS LEFT
Grade 2 - A FEW SPOTS LEFT
Address
*
Street Address
City
ZIP / Postal Code
Home Phone
*
Parent/Guardian Information
Parent 1 Name
*
First
Last
P1 CELL
*
P1 WORK
P1 Email
*
Parent 2 Name
*
First
Last
P2 CELL
*
P2 Work
P2 Email
*
Emergency Contact Information
Please indicate TWO emergency contacts aside from parents/guardians listed above
EC1 Name
*
First
Last
EC1 Cell
*
EC1 relationship to camper
*
EC2 Name
*
First
Last
EC2 Cell
*
EC2 relationship to camper
*
Carpool Information
The following people, including parents/guardians, are permitted to pick up my child without advanced notice to the office
*
Medical Information
List any known allergies and dietary restrictions here:
*
type N/A if none
Please describe any medical issues we should be aware of:
*
type N/A if none
Will the camper be taking any medication while at camp?
*
Yes
No
Permission to dispense prescribed medication
I agree
I hereby authorize Machane Maimo to administer children’s Tylenol when my child (ren) or any child in my custody is ill and upon verbal authorization when called by the Academy.
All medications will be kept in the camp office and will be administered by Head Counselors, Camp Director, or Office Staff at the indicated times.
By consenting here, I grant Machane Maimo permission to dispense the aforementioned medication(s) to my child.
Permission to dispense prescribed medication
I agree
If your child is currently taking prescription and/or over the counter medications, please list along with the reason.
In order to dispense prescription medications during camp, contact the Director.
I hereby authorize Machane Maimo to administer children’s Tylenol when my child (ren) or any child in my custody is ill and upon verbal authorization when called by the Academy.
All medications will be kept in the camp office and will be administered by Head Counselors, Camp Director, or Office Staff at the indicated times.
By consenting, I grant Machane Maimo permission to dispense the aforementioned medication(s) to my child. Any change in the type or dosage of medication will promptly be reported to the Camp Office.
List any medications that your child will need administered at camp
Signature
*
Release and Indemnification
Signature
*
I expressly release and indemnify Machane Maimo and its employees hold free and harmless, from any and all liability, charges, claims, costs, and expenses of every kind and nature whatsoever, including reasonable attorney fees, in connection with acceptance and participation of my child in your Machane Maimo activities. This release and indemnification is unconditional and without reservation of any kinds, except only for such acts or omissions that arise out of your intentional or negligent wrongdoing where there is no fault by my child, or failure to disclose pertinent information.
Registration
Full Session: June 21 - August 6 Full Day: 8:30 - 3:30 (M-Th) Half Day: 8:30 - 12:30 (M-Th) Friday: 8:30 - 1:30 (all campers) Tuition includes Nagila pizza on Fridays, camp t-shirt, admission fees, snacks and more! Non Refundable deposit: $250 (will be applied towards summer camp tuition fees) Camper spot is not guaranteed until deposit is paid. Tuition must be paid in FULL prior to June 15, 2021 or your spot will be forfeited.
Camp Registration - 2 year old group
Full Session - $2,100
Weekly Rate - $325 per week
Half day schedule 8:30 - 12:30 (FR: 1:30) campers entering Pre-Nursery
Weekly Sign Up
*
Week 1 - 6/21-25 ($325)
Week 2 - 6/28-7/2 ($325)
Week 3 - 7/5-9 ($325)
Week 4 - 7/12-16 ($325)
Week 5 - 7/19-23 ($325)
Week 6 - 7/26-30 ($325)
Week 7 - 8/2-6 ($325)
Camp Registration - 3 - 6 year old group
Full Session - $2,595
Weekly Rate - $375 per week
Half day schedule 8:30 - 2:30 or 3:30 (FR: 1:30) campers entering Pre-Nursery thru 2nd grade
Weekly Sign Up
*
Week 1 - 6/21-25 ($375)
Week 2 - 6/28-7/2 ($375)
Week 3 - 7/5-9 ($375)
Week 4 - 7/12-16 ($375)
Week 5 - 7/19-23 ($375)
Week 6 - 7/26-30 ($375)
Week 7 - 8/2-6 ($375)
Deposit
*
Price:
Pay in full
*
Price:
$0.00
Pay in full or deposit only?
*
Pay in full
Pay deposit only
Total
$0.00
Maimo Staff code? Enter it here.
Credit Card
*
Card Details
Cardholder Name
Δ