| Document Date: 2014-01-16 11:11:47
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City New York City / Broadway / / Company MasterCard / HEALTH INSURANCE COMPANY / / Currency USD / / / Facility MARVIN’S CAMP / Camp Application Please / Jewish Community Center / pre/post camp / Post Camp / DIABETES CAMP / INDEpENDENCE Diabetes Camp / BuILDING ONLY Mon / CAMp Early Bird Regular / Camp June / JCC Camp / CAMp pROGRAMs / JCC Lillian Schwartz Day Camp / MARVIN’ s CAMp Special Needs Camp / This camp / / IndustryTerm contracted transportation company arising / timely payments / transportation / overnight activities utilizing bus transportation / / Organization Fitness Center / Food Safety / Department of Health / Jewish Community Center / / Person Alan Bernikow / Mike Reape / / / Position attorney / Director / PHYSICIAN / pm pm pm pm pm / / ProvinceOrState New York / / Technology cellular telephone / /
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RELEAsE AND pERMIssION AGREEMENT JCC Lillian schwartz Day Camp The undersigned acknowledges that he/she has read and agreed to the following terms and conditions: A. The undersigned is the parent or legal guardian legal