Nathan & Shirley Rothner ATT Summer Program - Camper Application



Step 1: Camper Information

Camper's Last Name:
Camper's First Name:
Birth date:
Address:
City:
State:
Zip Code:
Home Phone:
School:
Grade Entering September 2018:
Mother's Title: (Mrs., Miss, Dr., etc)
Father's Title: (Mr., Dr., Rabbi, etc)
Mother's Name:
Father's Name:
Mother's Cell Phone:
Father's Cell Phone:
Mother's Work Phone:
Father's Work Phone:
Mother's Email Address:
Father's Email Address:
Is mother a full-time teacher in the ATT system?
Yes   No
Is father a full-time teacher in the ATT system?
Yes   No
If yes, school name:
If yes, school name:
   

Step 2: Camper Medical Information

Child's Physician:
Physician's Phone:
Name of Insurance Company:
Group Info:
Policy #:
Emergency Contact (If Parents are Unavailable):
Emergency Contact's Phone (If Parents are Unavailable):
Relationship to Child:
   
Does your child have any special medical conditions (i.e. asthma, allergies, medications, etc.)?
No
Yes  
If yes, please explain and mail Medical Action Plan (MAP) to ATT:
   
Is your child accompanied at school by an aide or are there any accommodations made for him/her?   No   Yes
I hereby authorize the Associated Talmud Torahs to provide emergency care should it be necessary.
I hereby permit my child to go on excursions off the premises with authorized ATT staff members.
I agree that all personal belongings left behind will be hefker (ownerless) 30 days after the camp season has ended.
My child has permission to:   Walk Home    Bike Home   Carpool Home
   

Step 3: Class Registration

Session 1:

Gender: Boy   Girl

Has a sibling already registered for ATT Summer Program?: Yes   No

Grade Entering September 2018: 1   2   3   4   5   6   7

No classes available
Time Choices Class Name Cost
9:00 - 9:30 Yes / No Tefillah & Learning N/C
9:30 - 10:30 1st 
2nd   
10:30 - 11:30 1st 
2nd   
11:30 - 12:30 1st 
2nd   
1:00 - 4:00 Trips 
       
    Total Class Tuition:
 
 
Session 2:
Time Choices Class Name Cost
9:00 - 9:30 Yes / No Tefillah & Learning N/C
9:30 - 10:30 1st 
2nd   
10:30 - 11:30 1st 
2nd   
11:30 - 12:30 1st 
2nd   
1:00 - 4:00 Trips 
       
    Total Class Tuition:
    Registration Fee: $75.00
       
  Discounts Available:
Early Bird Discount (registered by 3/15/18) less $50.00 per family
ATT Full-Time Teacher Discount: less $45.00 per class*
Sibling Discount: less $9.00 per class for sibling 2, 3, etc.*
* An ATT Full -Time Teacher Discount makes one ineligible for a Sibling Discount.

Late Fee (registered between 3/16/18 - 5/31/18): $50.00
Late Fee (registered after 6/1/18): $100.00

To confirm camper's total cost, please call 773-973-2828 and ask for Sandra Friedman. At that time all discounts, fees, and Grand Total will be calculated.
   

Step 4: T-Shirt Size

(Select one):
 

Step 5: Deposit Information

Application will not be accepted without a $100.00 deposit.
To pay by credit card, please call 773-973-2828 and ask for Sandra Friedman. Up to three credit card payments (Visa and MasterCard only) may be made. Please specify dates on which payments should be processed when speaking to Sandra.
To pay by check, please mail check to: ATT, 3531 Madison St., Skokie, IL 60076. ATTN: Sandra.
Please make deposits and post-dated checks payable to the ATT Summer Program. Bring or mail checks to:

ATT Summer Program
Attention: Sandra
3531 Madison St.
Skokie, IL 60076
 
close close
Adding to cart...
close close
 

Login to Your Account

Easily manage your shipping addresses, order history, and wish lists.
Username 
Password 
  Keep me logged in for 2 weeks
 Login
 Forgot your password?

Retrieve Password

Create a New Account

With your new account you can easily manage your shipping addresses, order history, and wishlists.
First Name
Last Name
Email Address
Password
Confirm Password
  Keep me logged in for 2 weeks
Register