Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
   First

Middle

Last

 
Address
   Street

City

State
Zip
Date of Birth
    
Contact Info
   Phone
Email
 
Schools
   School
Hebrew School Entering Grade:
Child's Mother
   Mother's Name
Hebrew Name Work Phone Cell
Child's Father
   Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
   Name

Phone

Relationship

 
Pediatrician
   Name

Phone

    

Email

      
           
Select Child's Age Group
Please  write your Child's age
 
    
 
  
 
    
 
  
Please indicate number of sessions your child will attend camp:

  Including lunch

 First Week, June 22 -June 26 Second Week, June 29 -July 3

Third Week, July 6 -July 10Fourth Week, July 13 -July 17
     
Please Purchase Camp Logo T-Shirt: $10 each

 Each camper needs to have at least one 

 Select Size

OPTIONAL: Caps with camp logo are also available for $10 each!
One size fits all
     
IMPORTANT
•
All forms must be completed and submitted before your child begins camp.
•
I will be paying by:  Credit Card
  Name on Card  
 

Credit Card Number  

Exp   CVV Code

Notes 

These fees will only be charged upon acceptance of your child 
I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
   
  Date of Application: