Winter Camp Registration 2019 - Brooklyn Scroll below the image for the registration form * Denotes required field Child Information First name* Last name* Date of birth (mm/dd/yy)* P.S. number* Room number Grade number* Allergies or medical concerns Home Address* City/State/Postal Code* Home phone number* Parent's Cell phone* Would You Like To Register Multiple Children* Yes No Child #2 First Name Jewish Hebrew Name Last Name Boy Girl Date of Birth (MM/DD/YYYY) P.S. Number Grade Child #3 First Name Jewish Hebrew Name Last Name BoyGirl Date of Birth (MM/DD/YYYY) Grade Payment information Released Time Winter Camp Fee $175 Sign up for Bus Transportation Service Yes No Method of Payment* - select - Visa Mastercard Check Cash Credit card number Expiration date - month - 01 02 03 04 05 06 07 08 09 10 11 12 - year - 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Name on Card CVV (3-4 digit code on card) Checks can be made out to : Released Time Program, 824 Eastern Parkway, Brooklyn, NY 11213 Email for confirmation* I heard about Released Time Winter Camp from Comments This page uses 128 bit SSL encryption to keep your data secure.
