youth@ostns.org
1600 Jonquil Street NW, Washington, DC, 20012, US
202-882-7225
Household Mailing Address
Additional Household Mailing Address
Full Name
Should my child(ren) become ill and a parent/guardian cannot be reached, please notify either of the following people:
In the event that I/we are not able to pick up my/our child(ren), permission is given to leave with the following individual(s):
I, the parent/guardian of the camper(s) listed on this form, authorize OSTNS to obtain immediate medical care and consents to the hospitalization of, the performance of necessary medical tests upon, the use of surgery on, and/or the administration of drugs to, my child(ren) or ward(s) if an emergency occurs when I can not be located immediately. It is also understood that this agreement covers those situations which are true emergencies and only when I cannot be reached. Otherwise, I expet to be notified immediately.
Sign Here
Date of Signature
Will Attend
Date of Birth
In order to secure your camper's spot, please submit a $100 NON-REFUNDABLE DEPOSIT PER CAMPER to Camp Kibbutz with your registration. Payment can be made online at https://ostns.org/donations_new.php or by check. Please include "Camp Kibbutz 2016 Deposit" in all payments and indicate name(s) of campers covered by deposit.