2021 KHHS Summer Camp Registration

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Keitanat Har HaShem Summer Camp is right around the corner, and we're excited for another great few weeks with you all! This year KHHS includes grades 1-6.

What We Know
The plan for summer is to play games, prepare for Shabbat, hear stories, make cool crafts, dance, and laugh as we always have. We will be outside every second we can.

Prior to camp, a COVID-19 screening form will be sent to each registered family.

Formal camp program begins at 9:00 am and concludes at 3:30 pm.
Pick-up is between 3:30 pm - 4:00 pm

Camp Session Dates:
Session 1: June 7-11
Session 2: June 14-18
Session 3: June 21-25
Session 4: June 28-July 2

Member Pricing
$314 / session

Non-Member Pricing
$375 / session

Campers attending all 4 sessions will receive a $100 discount on their full camp tuition!

Cancellation Policy

Full refund minus registration fee can be received with written notice of cancellation prior to May 12.
Should the camper or someone in the family become sick with Covid 19 or other illness preventing participation in camp, we will refund 50% of the fee with written notice Friday (prior to the opening day Monday) of the session. Notice of sickness after Friday prior to opening day will be eligible for 25% refund.

*Please register each child individually on a separate submission.
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To complete the registration form, you will need:

Medical & Insurance Information, Proof of Immunization (or Immunization Medical Exemption Form)
If your child may need to take medication while attending programs (even if they can administer the medication independently), you will need to complete the following Medical Release Form (Please note, this document require a physician's signature)
If your child receives specialized services, supports, accommodations or interventions at secular school, we'll ask you to upload any documents for our reference.

Camp is for everybody, and because it is important to us that camp be an option for all families in our community, we have a scholarship program. Unfortunately, scholarship monies are limited.

If you are in need of financial assistance, please complete and submit this form.
Form needs to be completed prior to May 7.

Please note that scholarship priority is given to Har HaShem families as membership dues help to underwrite our youth programs.
If you are a member of another congregation, please contact your home congregation for financial assistance first.

Please also note that we base KHHS activities and supplies on registration numbers. Therefore, there will be no refunds or credits issued if a camper attends only a partial week or decides not to attend without giving notice.
Har HaShem must be notified prior to May 12 in order to receive a refund on camp sessions.

* Are you a member of Har HaShem?

If no, and a member elsewhere, please indicate where below

* How did you hear about camp?

If other, please specify below

* Camper's FIRST Name

* Camper's LAST Name

* Camper's preferred pronouns

Please specify preferred pronoun here

* Camper's Birthday

* Camper Grade as of September 2021 (KHHS campers must be entering grades 1st - 5th as of Fall 2021)

* How many sessions will this camper be attending?

* Please check which session(s) your camper plans to attend

Session 1, June 7-11Session 2, June 14-18Session 3, June 21-25Session 4, June 28-July 2

* Does this camper have any medical allergies?

* Please list any and all allergies that we should be aware of here

Please tell us about any medications your children will take during camp -- even if he/she/they can take the medication independently, Har HaShem needs to know.

If we may need to administer medication, please complete the form below, have it signed by your doctor and return it to the Har HaShem Lifelong Learning office or email to our Learning Assistant, Chris, at cs@harhashem.org by May 21.

Medical Release Form

Please list any and all medications that we may need to assist with while attending camp here (with directions if necessary)

Har HaShem aims to create a safe, welcoming and productive environment for every child. Please share information that will help us do this for your child and family.

Har HaShem aims to include individuals who temporarily or permanently move, hear, see, touch, think, learn, communicate, process stimuli, and/or experience emotions differently. Our youth education programs welcome all children -- whatever distinct needs may be -- and we work toward creating meaningful, inclusive experiences for all.

We have a specialist on staff, Aryn Miller, who works with families to ensure youth with different needs are included and who helps our staff prepare to accommodate each camper's needs.

If you have any information about your child's needs in a learning environment, including diagnosis, condition, educational or social concern, learning difference, challenge with behavior, or any other distinctions of which we should be aware, please indicate below. We will reach out to you for more information.

About my Child

Is there anything else we should take note of to ensure your camper has the best possible time at camp?

* Parent 1 FIRST Name

* Parent 1 LAST Name

* Parent 1 Phone Number

* Parent 1 Email

Parent 2 FIRST Name

Parent 2 LAST Name

Parent 2 Phone Number

Parent 2 Email

* Emergency Contact

* Emergency Contact Phone Number

* Relationship to Camper

Please describe any custody arrangements of which we should be aware

* Medical Insurance Company

* Name of Policy Holder

* Plan/Group Number

* Policy Number

Insurer Phone Number (if available)

* Child's Physician

* Physician's Phone Number

Immunizations

Beginning with the launch of the 2020-2021 academic year, Har HaShem will require proof of immunization or an immunization medical exemption form. for participation in any youth education program or event (school, youth group, camp, etc.). This requirement brings us into alignment with the Youth & Camping Programs of the Reform Movement.

While we are aware parents may choose to defer the vaccination of their children, we believe this is a public health issue, especially in the confined environment of a many of our programs, and discourage deferment for any but medical reasons. Therefore, all students and staff will be required to have age-appropriate vaccines recommended by the Colorado Department of Public Health and Environment, American Academy of Pediatrics (AAP), and the Center for Disease Control (CDC).

You will be asked to upload proof of immunization from a doctor or an Immunization Medical Exemption Form as part of the registration process. If your child cannot get vaccines because of medical reasons, you must submit a properly completed and signed official form in that field. This form must be completed and signed by your child’s medical doctor.

* Please upload either proof of immunization OR the immunization medical exemption form here. Please note that both of these documents require a signature from your child's doctor.

If and when a child requires medical attention, Har HaShem personnel will make every effort to reach a parent or guardian. If we are unable to reach a parent or guardian, the following instruction will remain in force unless revoked by the parent or guardian:

I hereby authorize Congregation Har HaShem or its authorized representative to call my child’s physician (or another physician) for necessary care for my child in case of emergency. I agree to pay all expenses incurred. This authorizations shall remain effective from June 1, 2021 – July 1, 2021.

I further authorize Congregation Har HaShem or its authorized representative to consent to any x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed physician or surgeon, whether at the said physician’s office or licensed hospital.

I give this authorization in advance of any specific examination, diagnosis, treatment or hospital care being required, and in order to provide authority and power on any and all such examinations, diagnoses, treatments or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

* I grant Har HaShem the right to seek treatment for this child.

I grant Har HaShem the right to seek treatment for this child.

Parents and guardians, jointly and separately, release Congregation Har HaShem, its officers, agents, and employees from all liability for injuries, illness or property damage resulting from my family/child’s participation in Religious School and all Har HaShem sponsored activities and agree not to make any claim or demand against them for any or all losses or damages to student/family’s person or property. I have completed the above learning and medical information to the best of my knowledge. I have read all of the above and agree to abide by it.

* I release Har HaShem from liability

I release Har HaShem from liability

By completing this registration, I hereby give consent for photographs, film, video or sound recordings to be taken of anyone in my family at Congregation Har HaShem or at a Congregation Har HaShem sponsored activity during the 2020-2021 academic year (including 2021 summer activities as well), and I further consent that such photographs/recordings can be used in publications, promotional materials, news releases, film, video, websites or sound productions as directed and approved by Congregation Har HaShem.

If you do not wish for your child's image to be used, please indicate in writing by emailing Chris at cs@harhashem.org by May 28.

* I have read and understand the photography release

I have read and understand the photography release

Transportation Release

We are currently exploring whether or not we will be able take field trips this summer. Please fill this out should we be able to take field trips.

For field trips, the campers will be riding a school bus or RTD. I give permission for my child/children to ride the bus at all field trips. I understand that if I do not give consent, my child will not be able to participate in camp field trip days.

* Do you accept the Transportation Release and give permission for your child to ride the bus?

If you have any questions or concerns regarding your camper's stay, please feel free to contact our Camp Directors, Caroline & Leah, at camp@harhashem.org.

We look forward to seeing you all!

Total Camper Amount