Camp Keetov, Maryland: Summer 2024 Registration

Welcome to Camp Keetov!

Please complete this form to register your child for Camp Keetov at WHC's Julia Bindeman Suburban Center.

Questions? Please visit our website for more information or contact:

Kfirah HaLevi, Director RJWECC, khalevi@whctemple.org, 301-279-7505

FULL SCHEDULE & TUITION

2024 Camp Calendar

CHILD'S INFORMATION

First Name

Last Name

Prefers to be called

Pronoun

Date of Birth

Is your child enrolled in a non-WHC early childhood program?

YesNo

Name of School/Program

Which session(s) would you like to register for? (Choose up to 3)

Session 1 (June 3 - June 28) - closed June 12 & 19Session 2 (July 1 - July 26) - closed July 4Session 3 (July 29 - August 9)

How old will your child be as of June 3, 2024?

Toddler (16-23 months)Two yearsThree yearsPre-K (rising Pre-K or Kindergarten student)

We look forward to welcoming your family to our community. Please use this space if there is anything that you would like to discuss with us ahead of time so that we can arrange a phone call.

ACCOMMODATIONS

Do you need any accommodations to allow full participation in this event?

YesNo

What accommodations do you need?

Children Registered

Camp Totals

Camp Total

Extras Total

Grand Total

5% discount for siblings will be applied on your final bill

ENROLLMENT CONTRACT

I wish to enroll my child in Camp Keetov Summer 2024. With the submission of this form, I am also making a non-refundable and non-transferable payment to Washington Hebrew Congregation for the required

$300 security fee and

$

application fee for each child I enroll.

I understand that I will be billed and charged the balance of the camp tuition to the credit card or account provided on the following payment schedule:

FULL - I am prepared to pay tuition in full within one business weekINSTALLMENTS - I would like to pay in two installments. 50% within one business week and 50% on March 15, 2024

I understand that I will be billed and charged the balance of the camp tuition to the credit card or account provided within one business week.

I understand that I may withdraw my child from camp and receive a 90% refund of tuition up until April 15, 2024. After April 15, 2024, all tuition payments are non-refundable and non-transferable. I understand that my WHC account must be current in order for this application to be processed.

Adjustments to registration can be made until April 15. After that date, there are no refunds and any program transfer requests are at the Director’s discretion and must be submitted to Kfirah HaLevi at khalevi@whctemple.org.

All programs are pending sufficient enrollment and age groups may be combined.

Sibling Discount: 5% off lower tuition

I have read and agree to all of the terms outlined above

Yes

Parent's Electronic Signature

Date

PAYMENT

TOTAL COST

Number of Children Registered

Subtotal - $300 Security Fee + $50/75 Registration Fee Per Child

$

Admin Code? (Staff Use Only)

Discount Code

Amount Due Today

$

Deposit & Fee After Discounts

Deposit Subtotal

Registration Fee Subtotal

Deposit Final after Discount

Fee Final after Discount

Refund policy

PAYMENT METHOD

How would you like to pay your bill?

Credit CardACH (Direct Bank Debit)

CREDIT CARD INFORMATION

To help defray the cost of WHC's credit card processing, a 3% fee will be added to your to credit card payments. There is no fee for ACH payments.

Fee Amount

$

Grand Total

$

First Name on Card

Last Name on Card

Credit Card Number

Expiration Month

Expiration Year

CVV

Different billing address?

Billing Street

Billing City

Billing State

Billing Zip Code

ACH INFORMATION

Bank Account Type

CheckingSavings

Bank Name

Account Holder's Name

Bank Account Number

Bank Routing Number

Publicly Hidden Fields

Payment Section

Hide Payment Info

Hidden

Portal Pre-Fill Fields

Account ID

Contact ID

Outreach/Event Pre-Fill

OutreachID

DesignationID

Auth.net Connector Billing Info

Gateway Address

Gateway City

Gateway State

Gateway Zip

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Gateway Quantity

Gateway Amount

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