CAMPER INFORMATION

Camper's Name:*
Sex:*
Camper's Email:*
Home Fax:*
Camper's Address:*
City:*
 
State:* Zip:* Country:
Home Phone:*
Date of Birth:*
Mo: Day: Year:
School Name:
 
Grade in School as of Sep. 2005:*
Grouping Request:

PARENT INFORMATION

Father's Name:
Father's E-Mail:
 
Home Phone:
 
Work Phone:
 
Cell Phone:
Mother's Name:
Mother's E-Mail:
 
Home Phone:
 
Work Phone:
 
Cell Phone:
Address:
City:
 
State: Zip: Country:

IN CASE OF EMERGENCY

Name:
Relationship:
 
Home Phone:
 
Work:
Address:
City:
 
State: Zip:   Country:

HOW DID YOU HEAR ABOUT JULIAN KRINSKY CAMPS AND PROGRAMS?

Previously Attended JKCP
Which Camp:
Number of Years:
From Another Camper
Name:
Advertisment
Publication:
Camp Fair
Name:
Camp Referral Agency
Name:
Teacher/Coach/Pro
Name:
Other

FOR COMPLETION BY PARENT/GUARDIAN

I give my permission for my son/daughter to participate in the 2005 Julian Krinsky Canyon Ranch program. I agree that my son/daughter will abide by the camp rules and realize any breach of these rules may result in his/her immediate dismissal without refund of any fees.

I authorize Julian Krinsky Canyon Ranch, or its authorized representatives, to take whatever actions it may consider warranted under the circumstances regarding my child's health and safety. I fully release Julian Krinsky Camps & Programs and its authorized representatives from any liability for such circumstances or actions as may be taken in connection therewith.

I authorize Julian Krinsky Camps & Programs, or its authorized representatives, at its discretion, to place my child, at my expense and without further consent, in a hospital for medical services and treatment, or if no hospital is readily available, to place my child in the hands of a licensed doctor for treatment. Camp may elect to access my family health/accident policy.


Julian Krinsky Camps & Programs retains the right to use photographs of this camper for advertising purposes.

I have carefully read the above information and agree to the conditions stated.

For consent, please check box
Please check here if any medical, physical or other conditions may limit your child's ability to fully participate in any activity.

PLEASE CHECK SESSIONS DESIRED:

Two-week Residential Program
 
Two-week Day Program
(8:45 a.m. - 3:45 p.m.) 
1. June 26 - July 9, 2005 1. June 28 - July 9, 2005
2. July 10 - July 23, 2005 2. July 12 - July 23, 2005
3. July 24 - Aug 6, 2005 3. July 26 - Aug 6, 2005
Single room request
   


Please note the following options available:



PRICING AND FEES:

Residential
Tuition, board & lodging and 9 personal services
$ 2,890.00 (sessions 1 & 2)
$ 1375/week (session 3)
Trips (weekdays, Saturdays and Sundays including all entertainment and recreation admission fees)
$ 130.00
Course materials (yoga mats, art supplies, towels, laundry bags, journals, rock-climbing fee, biking, etc.)
$ 100.00
Single room (subject to availability)
$ 200.00
Day
Tuition, lunches and 3 personal services
$ 900.00 (sessions 1 & 2)
$ 450/week (session 3)
Course materials (yoga mats, art supplies, towels, journals, rock-climbing fees, biking, etc.)
$ 100.00
Extended afternoon
$ 50/week
Extended morning and breakfast
$ 50/week

OPTIONAL SERVICES :

Linen service:
$12/week
Laundry service:
Charged by the pound (please note that students prefer to use the laundry room located on each floor of the dorms.
Transportation to and from Philadelphia International Airport:
$30 one way, $50 round trip
Van shuttle to/from New York City, Tarrytown or Newark Airport:
$60 one way, $100 round trip (Tarrytown, New York City or Newark Airport)
Overseas camper surcharge:
$150 per camper
(includes local airport pickup and drop off, laundry and linen services)

PAYMENT DETAILS:

A $750 deposit plus a $50 non-refundable application fee for overnight campuers or a $350 deposit plus a $50 non-refundable application fee for day campers must be sent under seperate cover within two weeks of submitting application. Full payment is due April 1, 2005 or enrollment may be subject to cancellation. Reservations are made in order of receipt. We will notify you if preferred weeks are not available.

Refund/Cancellation Policy: Notification of withdrawal must be made in writing to the camp. Refunds will be made as follows:

Withdrawal Date:       By May 1st        May 2nd and later
Amount of Refund:
  All but $300   No refund without cancellation insurance*

*Julian Krinsky Camps & Programs offers cancellation insurance that provides a refund of all but $300 of your total payment. The price of insurance is 5% of your tuition. There will be no refund of tuition after May 1st if cancellation insurance is not paid in full by that date.

Even if cancellation insurance is paid for, there will be no refund for a camper who is asked to leave the camp for the use of drugs or alcohol, non-notification of a serious medical condition, or whose conduct is detrimental to the camp. These decisions are at the sole discretion of Julian Krinsky Camps and Programs. No refund will be made for late arrival, early departure, or withdrawal due to family vacation.

Please send payment with check(s) payable to:

Julian Krinsky Camps & Programs
610 S. Henderson Rd.
King of Prussia, PA 19406 USA

Phone: (610)265-9401 or 1(866) TRY-JKCP
Fax: (610) 265-3678

Payment of Fees for Overseas Campers:

1. Money should be transferred to Wachovia Bank, Philadelphia, PA 19101.
2. ABA (routing) # 031201467
3. Swift: PNBPUS33
4. Deposit payment to: JKST, Inc. A/CT #2000013367204
5. Reference: Camper's Name / Canyon Ranch

SUBMIT APPLICATION:

Thank you for submitting your application. We look forward to seeing you soon.

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