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TO REGISTER PLEASE ENTER YOUR PARENT ID NUMBER

If you would like to register a new camper please contact the camp office at 908.90.LEEBA or office@campleeba.com

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Parent information

Family Name*

Home Phone*

Title*

Fathers Name*

Fathers Email

Fathers Cell

Mothers Name*

Mothers Email

Mothers Cell

Preferred Contact for Updates and Important Messages:

Text*

Email*

ADDRESS

Street*

City*

State*

Zip*

Check here to add summer address

SUMMER ADDRESS

Street*

City*

State*

Zip*

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CHILD INFORMATION

First Name*

Last Name*

Date of Birth*

Grade Going Into*

School*

Camp Session*

Does This Child Have Any Physical Heath Issue?*

Does This Child Have Any Allergies?*

Does This Child Have Any Mental Health Issues?*

Does This Child Take Any Medication Daily? *

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BUNK REQUESTS

Please fill out at least two girls that your daughter would like to be together with for the summer. If you specifically do not want your daughter to be with a certain girl, please notate that in the comments box.

First Half

1*

2*

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Comments:

Second Half

1*

2*

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4

Comments:

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EMERGENCY CONTACTS

First Name*

Last Name*

Relation*

Cell Phone*

First Name*

Last Name*

Relation*

Cell Phone*

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TRANSPORTATION

We will once again be using Presidential Bus Company as our transportation provider. All buses will be fully air conditioned to make your daughter/s ride as comfortable as possible.
Although transportation is not mandatory we strongly encourage all parents to send their children on the bus as it makes for a smoother arrival and dismissal for everyone. We hope to be able to provide transportation to all locations in Lakewood, Jackson and Toms River. At this time we can only guarantee stops within a 7-mile radius from Camp Leeba. Please call the office to discuss transportation if you are outside the 7-mile radius or if you live in any other town. Please understand that we cannot guarantee transportation to any location after registration closes.

Would you like transportation for your daughter/s?

First Half

Current BOE Bus Stop*

Second Half Same As First Half

Current BOE bus stop*

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AUTHORIZATION & AGREEMENT

I hereby authorize Camp Leeba or a designated representative to act on behalf of my daughter/s as they deem necessary in case of an emergency. I hereby give permission for my daughter/s to participate in all Camp Leeba trips and activities. I hereby release Camp Leeba, its directors and/or its employees from any and all liability claims and demands for any loss, damage or injury of any kind that may occur in Camp Leeba. I have read the Camp Guidelines and will have my daughter/s comply with them.

By registering your daughter/s and sending in your deposit you are committing to your slot and payment in full. In the event that you should need to cancel for any reason, Camp Leeba reserves the right to absolve you of your obligation at their discretion, but there will always be a $100 cancellation fee for each trip for each camper.
In the unlikely event that camp will not be able to operate due to unforeseen circumstances, a small portion of your deposit may not be refunded, as at a minimum we must cover costs that we will incur whether or not camp opens.

Parent Name (Print):*

Parent’s Signature*

Date*

Please make sure you checked off the above two boxes in order to continue your application.

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PAYMENT

The total amount for Camp is $

In order to enroll your daughter/s, you are required to submit two checks as follows:

A deposit in the amount $ which should be payable now.

A post-dated check dated no later than June 3 2024 for your remaining balance of $ Deposits and postdated checks must be received within 3 days of submitting your application. Your daughter/s spot is not reserved until your deposit and postdated checks are received, even though you submitted your application online.

Checks should be made payable to Cash only. If you are unable to make your checks payable to Cash or have any other questions please contact the business office at 848.525.3470. Please put your daughter/s name on the memo line of the checks, and mail or drop off at: Camp Leeba 501 Eagle Point Drive Toms River NJ 08753

YOUR APPLICATION IS NOT SUBMITTED UNTIL YOU RECEIVE AN EMAIL CONFIRMING YOUR APPLICATION

Camp Leeba Application 2024