Mid Winter Camp - Staten Island

Our camp caters to Jewish children studying in public schools across Staten Island. we offer daily arts and crafts; sports and trips, alongside healthy nutritious meals twice daily. Your child will make new friends and be proud to be a Jew!
We begin at 9:30 every morning through 3:30 P.M., transportation is available to and from camp for an extra cost of $15 per day. 

 *Scroll down the page to fill out the form

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* Denotes required field


Child Information
First Name*
Jewish Hebrew Name
Last Name*
Boy  Girl 
Date of Birth (MM/DD/YYYY)*
Home Phone Number*
Mother's Name*  
Mother's Cell*
Mother's Work Phone
Mother's Email*
Father's Name*
Father's Cell*
Father's Work Phone
Father's Email*
P.S. Number*

Were there any conversions and/or adoptions in the family?*
If yes, please explain

Is mother Jewish by birth?*  Yes   No
Is father Jewish by birth?*  Yes   No

Would You Like To Register Multiple Children*
If registering more than one child, please call the office at 718-735-0215 for our 'Sibling Discount'
 Yes   No
Child #2
First Name
Jewish Hebrew Name

Last Name
 Boy  Girl
Date of Birth (MM/DD/YYYY)
P.S. Number

Child #3
First Name
Jewish Hebrew Name

Last Name


Date of Birth (MM/DD/YYYY)

P.S. Number


Medical Information

Does your child have any allergies or medical conditions?*                    If yes, please explain

Emergency Contact Person*
Emergency Contact's Phone Number*
Child's Doctor*
Doctor's Phone Number*
I give permission for my child to be photographed or videoed as part of his/her and other children's enjoyment, and for possible use in advertising and promotions.

Payment Information
Released Time Mid Winter Camp   $160.00
Home Pick-up and Drop-off   $60.00 
Method of Payment*  
Credit Card Number
Expiration Date
Name on Card

Checks can be made out to:

Released Time Program
824 Eastern Parkway
Brooklyn, N.Y.

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