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    

 

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

Camp dates: Monday, Dec. 27- Friday Dec. 31

The price of camp includes a hot lunch
Monday, Dec. 26 Tuesday, Dec. 27Wednesday, Dec. 28Thursday, Dec. 29

Friday, Dec. 30
     
Please Purchase Camp Logo SweatShirt: $10 each

Each camper needs to have at least one

Select Size
     
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

Total amount to charge to card

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: