2024 CHHS Summer Camp Registration

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Camp Har HaShem Registration is Open!

Camp Har HaShem (CHHS) 2024 is right around the corner! We can't wait to see your kid at camp in June. We'll play games, prepare for Shabbat, hear stories, make cool crafts, dance, go on fun field trips to amazing places, and laugh!

This summer we will be offering one fantastic week of camp: JUNE 3-7!
Our camp program begins at 9:00 am and concludes at 3:30 pm.

Member and Non-Member Pricing: $450 for the week

If you have any questions, please don’t hesitate to reach out to our awesome camp leaders, Leah Boonin and Caroline Saliman, at camp@harhashem.org.

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 April 6th.

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 CHHS 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 13 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?

From whom/what other source did you find out about camp?

* Camper's FIRST Name

* Camper's LAST Name

Please specify camper's preferred pronouns:

* Camper's Birthday

* Camper Grade as of September 2024 (KHHS campers must be entering grades 1st - 5th as of Fall 2024)

* 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 Program Coordinator, Karli, at ka@harhashem.org by May 20.

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.

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:

Child Insurance Information:

* 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

Har HaShem requires proof of immunization or an immunization medical exemption form and proof of Covid vaccinations 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 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 and your child's Covid vaccination card 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.

Har HaShem Wellness Understanding:

* I agree that my child will join you each day at camp only if they do not have any symptoms of illness. If they are feeling unwell, they will stay home.

I agree that my child will join you each day at camp only if they do not have any symptoms of illness. If they are feeling unwell, they will stay home.

Immunization/Vaccination Uploads:

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, 2024 – July 1, 2025

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 2024 year (including 2024 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 Karli Atwell at ka@harhashem.org by May 27.

* I have read and understand the photography release

I have read and understand the photography release

Transportation Release

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 experience, please feel free to contact our Camp Directors, Caroline & Leah, at camp@harhashem.org.

We look forward to seeing you all!

Total Camper Amount