Riverdale Temple Summer Camp 2026 Application - Form

NURSERY SCHOOL
SUMMER CAMP
APPLICATION

Thank you so much for your interest in our Summer Camp Program! Riverdale Temple Nursery School is a warm and nurturing environment due to our dedicated and caring teachers and our amazing families.

About Your Child

* Child's First Name

* Child's Last Name

* Date of Birth

* Gender

* Has your Child had previous Nursery School experience?

Please list your Child's previous Nursery School below:

Registration Information

* What age group are you interested in registering for?

* Please select each of the weeks you are interested in your child attending. (Minimum of 3 weeks must be selected)

Entire Summer Camp Schedule | June 29 to August 14
OR CHOOSE YOUR SPECIFIC CONSECUTIVE WEEKS BELOW (Minimum of 3 successive weeks must be selected, at a rate of $550.00 per week for 9:00am to 1:00pm.)Week 1 | June 29 to July 2Week 2 | July 6 to July 10Week 3 | July 13 to July 17Week 4 | July 20 to July 24 (no camp July 23)Week 5 | July 27 to July 31Week 6 | August 3 to August 7Week 7 | August 10 to August 14

* Please select each of the weeks you are interested in your child attending. (Minimum of 3 weeks must be selected)

Entire Summer Camp Schedule | June 29 to August 14
OR CHOOSE YOUR SPECIFIC CONSECUTIVE WEEKS BELOW (Minimum of 3 successive weeks must be selected, at a rate of $625.00 per week for 9:00am to 3:00pm.)Week 1 | June 29 to July 2Week 2 | July 6 to July 10Week 3 | July 13 to July 17Week 4 | July 20 to July 24 (no camp July 23)Week 5 | July 27 to July 31Week 6 | August 3 to August 7Week 7 | August 10 to August 14

* My payment preferences are:

2026 Summer Camp Security Fee

$100 | Mandatory Security Fee

2026 Summer Camp Deposit Fee

$500 | Summer Camp Deposit Fee

About Your Family

* Are you a Riverdale Temple Member Family?

* Is there more than one Parent/Guardian to list below?

Primary Parent/Guardian Information

* First Name

* Last Name

* Mobile Phone Number

* Email

Business Information

Occupation

Work Phone Number

Secondary Parent/Guardian Information

* First Name

* Last Name

* Mobile Phone Number

* Email

Business Information

Occupation

Work Phone Number

Home Information

* Address (w/apt #, if applicable)

* City

* State

* Zip Code

Home Phone Number

Emergency Contact & Authorized Pick Up

* Emergency Contact Name

* Emergency Contact Phone Number

Additional Emergency Contact Name

Additional Emergency Contact Phone Number

Please list the names of anyone who is authorized to pick up your child below:

Additional Information About Your Child

Please tell us how you heard about our program below:

What could you tell us about your child that will help us to make this a happy and fulfilling camp experience?

What special talents/special needs/learning challenges does your child have?

* Has your child been evaluated for any special needs?

What were the results of the evaluation, including any medication prescribed?

* Does your Child have allergies?

Please list your Child's allergies below:

Registration Fees and Parent Signature

* I/We understand to hold a spot in camp there is a minimum of a $500 deposit due today of the total amount below. I/We further agree to fulfill all payment policies and abide by all policies set forth by Riverdale Temple Nursery School/Camp.

I/We understand to hold a spot in camp there is a minimum of a $500 deposit due today of the total amount below. I/We further agree to fulfill all payment policies and abide by all policies set forth by Riverdale Temple Nursery School/Camp.

* Parent/Guardian Digital Signature

* Date