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Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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Joey Travolta’s Short Film Camp - Summer 2017
Presented by: MarbleJam Kids
Location: ACADEMY OUR LADY OF MOUNT CARMEL - 10 COUNTY ROAD, TENAFLY, NJ 07670 Dates: July 10th – July 21st, 2017 Times: 10:00 am - 3:00 pm, Monday-Friday
CAMP REGISTRATION Fee: $75.00* – for ALL RETURNING CAMP APPLICANTS* (Returning Campers, or enrollees known to MJK with current Intake on file, need only to pay $75 Registration Fee)
CAMP INTAKE REGISTRATION Fee: $200.00** – for ALL NEW CAMP APPLICANTS** (For new clients unknown to MJK: This fee includes new applicant INTAKE fee $125.00 to be scheduled, and the above $75.00 Camp Registration fee)
2017 FILM CAMP TUITION: $2,000.00
Non Refundable Registration Fee: $75.00 * or $200.00**, per camper, due with completed application.
Applications: Must be COMPLETE and accompanied by $75.00* or $200.00** Registration Fee
Tuition Deposit: $500.00 of Camp Tuition, Due March 1st, 2017
Tuition Balance: Remaining Tuition Paid in Full, Due May 15th, 2017
*Registration Fee Waiver: Returning Campers, or current MJK enrollees, who pay tuition IN FULL by March 1st, will be forgiven the Registration Fee.
Requirements to attend this camp are as follows:
Individuals must be between the ages of 10-23
Enrollment open to typical peers and individuals with ASD or other special needs who function at a level that enables them to participate fully in this program.
Requirement level includes the following:
Must have good attending skills
Must demonstrate behavior that will not impede active and effective participation in camp
Verbal skills preferred
Must participate in the program in its entirety (see sample schedule)
Must be accompanied by qualified support staff (provided by the family) if support staff (1:1) is required at school.
Must be able to work in groups of 6 with one adult support person.
Space is limited. Please complete One Form per Applicant. Submit your child’s application today! Contact: MarbleJam Kids: Phone: 201-497-6512 Fax: 201-942-4450
Email: jtfilmcamp@marblejamkids.org Visit www.marblejamkids.org to download application.
RETURN 6 pages total, Including: 2017 Payment Form with Tuition Agreement Signature, PLUS 2017 Registration Form, PLUS 3
pages of 2017 Camp Application Questionnaire, PLUS Release Form
Mail to: JTSFC Administrator MarbleJam Kids Inc • 954 Kinderkamack Road, Suite 1 • River Edge, NJ 07661
Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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2017 FILM CAMP REGISTRATION FORM
MarbleJam Kids, Inc. Family Name: ________________________
Participant Registration Please complete ONE FORM per camper
_______________________________________________________________________________________________
PARTICIPANT’S NAME: (last) ________________________________ (first) _____________________________
Birth Date: ____________________ Age: ____________Male: ____ Female: _____ Special Needs Y____ N ____
School Attending _______________________________ Grade (Completed Spring 2017): _________
Teacher reference name: ______________________________ email: __________________________________
School Phone: ___________________________________
_______________________________________________________________________________________________
PARENT NAME 1: __________________________________________________________
Street: _______________________________ City: __________________ State: ______ Zip: _________
HOME PHONE #: _______________________________CELL PHONE #: __________________________________
EMAIL: (Please PRINT) _____________________________ @ ___________________________________________
PARENT NAME 2: __________________________________________________________
Street: _______________________________ City: __________________ State: ______ Zip: _________
HOME PHONE #: _______________________________CELL PHONE #: __________________________________
EMAIL: (Please PRINT) _____________________________ @ ___________________________________________
______My non-refundable registration fee of $75.00 or $200.00 is enclosed. Check # _________ Credit Card ______
_______________________________________________________________________________________________
MJKs Office Use:
Date Form Completed/Updated: _____________________
Registration Current: Y / N, Known Applicant: $75.00_______
New Applicant: $200.00_____________
Intake Scheduled Date: __________ Therapist: ____________ Intake Complete (Therapist Init):________
Comments: _________________________________________
MJKs Camp REG FORM 11/2015
Engaging the mind, moving the body, enriching the soul, sharing smiles…
MarbleJam Kids Inc. 954 Kinderkamack Road, Suite 1, River Edge, NJ 07661 P/ 201-497-6512 F/201-942-4450 www.marblejamkids.org
DAILY FILM CAMP PRODUCTION SCHEDULE (example)
Day 1: 10:00am: Check-in, Introduction, Opening Dancing, Group assignments 10:30am-12:00pm: Orientation to classroom groups (Divided according to age), Intro. to Acting Exercises, Film Terms 12:00pm-1:00pm Lunch 1:00pm-3:00pm Groups Short Film Development
Day 2:
10:00am-12:00pm Dancing, Acting Exercises, Film Terms 12:00pm-1:00pm Lunch 1:00pm-3:00pm Continue to Develop Script & Intro. to Lighting
Day 3:
10:00am -12:00pm Dancing, Acting Exercises, Film Terms 12:00pm-1:00pm Lunch 1:00pm – 3:00pm Introduction to Camera, Locking Script, Pitch Film Ideas to Director
Day 4:
10:00am -12:00pm Dancing, Acting Exercise Film Terms, Interviews with Director 12:00pm-1:00pm Lunch 1:00pm-3:00pm Casting Film, Script Budget Breakdown, Interviews, First Group Shoot begins
Day 5:
First Group Shoot Day 10:00am -12:00pm Dancing, Acting Exercise Film Terms, Interviews 12:00pm-1:00pm Lunch 1:00pm-3:00pm Casting Film, Script Budget Breakdown, Commercials, Set Design, Wardrobe, Interviews
Day 6: Second Group Shoot Begins 10:00am -12:00pm Dancing, Acting Exercises, Film Terms, Animation 12:00pm-1:00pm Lunch 1:00pm-3:00pm Third Group continue prep of films, Animation, First Group Editing
Day 7: Second Group Shoot Day 10:00am -12:00pm Dancing, Acting Exercises, Film Terms, Animation, Commercials 12:00pm-1:00pm Lunch 1:00pm-3:00pm Film Exploration, Third Group Shoot as able
Day 8: Third Group Shoot Day 10:00am -12:00pm Dancing, Acting Exercises, Film Terms, Animation 12:00pm-1:00pm Lunch 1:00pm-3:00pm Post production, Editing, commercials
Day 9: Third Group Shoot Day and Pick-ups 10:00am -12:00pm Dancing, Acting Exercises, Film Terms, Editing Third Group 12:00pm-1:00pm Lunch 1:00pm-3:00pm Post production, Editing Film, Animation
Day 10:
10:00am -12:00pm Dancing, Pick-ups, Acting Exercises, Film Exploration, Editing 12:00pm-1:00pm Lunch Pizza Party 1:00pm-3:00pm Screening of rough cut of films, On-camera Testimonials, Goodbyes
Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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Camp Tuition Schedule Requirements and Cancellation Policy
Please read carefully and sign signature page.
TUITION BALANCE DUE in full by MAY 15th, 2017
REGISTRATION FEE: A non-refundable registration fee of $75.00 or 200.00 per camper must accompany this application and be
received in order to hold your spot. First come first served to fill camper spots. (If your new camper child is not selected for
participation after a completed scheduled INTAKE, the fee will be refunded, less $100.00)
TUITION PAYMENT DEPOSIT: $500.00 due March 1st, 2017* for ALL accepted registrations
*Registration Fee Waiver- awarded to returning campers or current MJK enrollees paying TUITION IN FULL by March 1, 2017.
TUITION PAYMENT IN FULL: remaining tuition portion balance up to $1500.00 due MAY 15th, 2017. Must remit payment
directly to MarbleJam Kids. If you are expecting funding support from DDD, school district, or any other funding organization, fees
must be submitted to MarbleJam Kids by the above due dates. No exceptions. Families are required to explore, apply, and confirm
supplemental tuition funding on their own. In the event that MarbleJam Kids receives a tuition supplement directly from a funding
source, the money will be applied to your child's account and families will be promptly reimbursed the amount already paid.
CAMP TUITION ASSISTANCE APPLICATION: available April 15th, 2017 - assistance is determined by the outcome of
fundraising efforts. Maximum assistance per qualified applicant is $675.00. Children receiving NJ DDD camp funding are NOT
eligible for this program.
PAYMENT PLAN OPTION Please contact MarbleJam Kids directly to design a monthly payment plan option for camp tuition
IMMEDIATELY when submitting application. Please do not wait until payment due dates, or fee schedule cannot be altered and child
may have to forgo camper spot.
CANCELLATION POLICY: Cancellations with request for refund, less $75.00 or 200.00 registration fee, accepted in writing
before May 1st, 2015. All cancellations after May 1st are NOT eligible for refund. Tuition Payments will be considered a tax
deductible donation to the charity.
*TUITION TIMELINE
December 28th, 2016: Open enrollment begins for JTSFC 2017 – Registration Fee $75.00 or $200.00 due with
application.
March 1st, 2017*: $500.00 Tuition Deposit due
Plus $75.00 or 200.00 Registration Fee if not previously submitted.
*Registration Fee Waiver award with FULL TUITION PAYMENT submission
May 1st, 2017: Final date accepted for Cancellations with refund, less $75.00 or $200.00 registration fee.
May 15th, 2017: Final Tuition Balance Payments Due – remaining tuition portion balance up to $1500.00.
Payment totals at this time = $2,075.00 or $2,200.00 to MJKids
*Late Payments: Payment due dates noted above are firm. Payments received after above dates incur a $25.00 late
fee. Late fees apply to monthly payment plans as well.
Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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2017 Joey Travolta’s Short Film Camp APPLICATION (Please Complete One Form per Applicant)
Applicant Name: ______________________________________________ Age ______________
Date of Birth: ________________ Gender: Male Female
Home Address: ____________________________________________________
_____________________________________________________
Home Phone: __________________________________ Email: ________________________________
Mother/Guardian Name: _____________________________ Cell/Work Phone: ____________________
Father/Guardian Name: ______________________________ Cell/Work Phone: ____________________
T-Shirt Size (Circle): Adult Sizes: AS AM AL AXL
Youth Sizes: YL (14-16)
School Attending: ____________________________________Grade (Completed Spring 2017): _______
Mandatory: Please provide a school reference (e.g. teacher, principal, counselor, behaviorist):
Name of Reference: __________________________________________ Phone: ____________________
E-Mail: ___________________________________________________ Fax: ______________________
1. Has your child been diagnosed with a disability?
No: Peer Participant* ____ *(Peer participant: some questions may not apply.)
Yes: ____ please describe:
__________________________________________________________________________________
__________________________________________________________________________________
2. Describe your child’s interests and educational program: (Favorite activities, topics of interest, school
program, community program, in school and/or private therapies, etc.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Does your child require a personal 1:1 aide at school? No Yes
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Camper Name ____________________________
4. Will his/her aide be attending this film camp? No Yes
Aide’s Name: ____________________________________________________
5. How does your child understand and interpret information? (Reads, uses written notes to assist with
auditory understanding, writes, uses picture schedule or written schedule, etc.)
__________________________________________________________________________________
__________________________________________________________________________________
6. How does your child communicate?
Conversational Phrases Single Words Points to Pictures ___ Aug. Comm. Device ____
7. What support helps your child communicate better? Verbal Prompts ___ Pictures ___ Written Text ___
Please describe:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
8. What is challenging for your child in a large group?
Attending Asking Questions Responding Compromising Contribution to a Group ___
Accepting Feedback Listening to Other’s Opinions Staying on Track with Task ___
Other; please describe:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
9. What challenging behaviors does your child experience? (Aggression towards classmates/adults, leaving
areas without permission, tantrums, fighting, verbal abuse, refusing to complete work, etc.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Camper Name ____________________________
10. Does your child? (Y/N) Ask Questions Stay on Topic of Other’s Interest Discuss Topics of Own
Interest Ask for More Information Make Comments About What Others Say ___
__________________________________________________________________________________
__________________________________________________________________________________
11. What type of behavioral support does your child receive?
__________________________________________________________________________________
12. Behavior Intervention Plan (Please Attach!) Behavior Services; please describe frequency of support, how
support is provided, if assistants are present/what they do:
__________________________________________________________________________________
__________________________________________________________________________________
13. In what situations is your child the most comfortable?
__________________________________________________________________________________
__________________________________________________________________________________
14. What situations make your child uncomfortable? (What happens, what makes the situation worse, what
helps most?)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
15. What would you like to see your child get out of this experience?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________
Name of Parent or Guardian
_________________________________ ______________________________
Signature of Parent or Guardian Date
Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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2017 Film Camp Release Form
CAMPER NAME: ____________________________________________
2017 Full Release and Indemnification Agreement Form
Joey Travolta’s Short Film Camp (mandatory for participation)
For and in consideration of my child’s, ______________________________(please print name), participation
in the Joey Travolta Short Film Camp (date) July 10th, 2017 through (date) July 21st 2017 and other valuable
consideration, the undersigned parent(s) or guardian(s) consent to their child participating in all activities
associated with the camp and release MarbleJam Kids Inc, Little Documentary Films, LLC, and Academy of
Our Lady of Mount Carmel, its members, employees, officers, and/or Board of Directors and all participating
volunteers and campers from any liability or claim resulting from any accident or injury sustained by my family
member during the camp activities. Further I/we agree to indemnify and assume all expenses, costs and fees,
and losses arising from said injury or accident to said family and to hold MarbleJam Kids Inc, Little
Documentary Films, LLC, and Academy of Our Lady of Mount Carmel, its members officers and/or Board of
Directors, employees and volunteers, consultants, and all campers free and harmless there from.
_____________________________ _____________
Signature of Parent or Guardian Date
2017 Photograph/Video and Name Release Form
Joey Travolta’s Short Film Camp (mandatory for participation)
I give my permission to post photos/release video and use my child’s first name ____________________
(please print name) on the websites of MarbleJam Kids Inc., Full Inclusion Films, and other promotional
material for the Joey Travolta Short Film Camp as well as for research, teaching publications, film festivals,
media, and documentation.
_____________________________ _____________
Signature of Parent or Guardian Date
Engaging the mind, moving the body, enriching the soul, sharing smiles… _____________________________________________________________________________________________________________________________ _______________________
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2017 Film Camp Payment Form Camper Name: ___________________________ I fully understand and agree to comply with MarbleJam Kids Camp Tuition Schedule Requirements for
Payment and Cancellation Policy, as outlined. Application will not be honored if this area is left unsigned.
Name: __________________________________________
Signature: ______________________________________ Date: ________________
Send Payments to: MarbleJam Kids
954 Kinderkamack Road, Suite 1
River Edge, NJ 07661
Attn: JTSFC Administrator
Please Accept My Check Payable to ‘MarbleJam Kids’: Amount $_________
My check # _________ is enclosed for: Registration _______ Deposit Payment in Full _______
Please accept my Credit Card Payment: Amount $_________
Name: ______________________________________________ (As it appears on card)
Billing Address: ______________________________________ Phone: ___________________
______________________________________
Visa ______ Master Card ______ AMEX ______ Discover ______ Amount: $________________
Card #_____________________________________________________ Exp. Date: ________________
V-Code ___________________ Signature: _____________________________________
Below to be completed by MJKs Staff:
Registration Fee: Date Received: _______________ Amount: $75.00 or 200.00 CC payment ________ Check # _______
Tuition Deposit: At least $500 Date Received: ________________ Amount: $______________ CC payment ________ Check # _______
Balance Due: ___________
Tuition Balance Payments: Date Received ________________ Amount: $____________ CC payment ________ Check # _______
Date Received ________________ Amount: $____________ CC payment ________ Check # _______
Date Received ________________ Amount: $____________ CC payment ________ Check # _______
Date Received ________________ Amount: $____________ CC payment ________ Check # _______
Paid in Full, Date Complete __________