Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. Please use a separate form for each child. Click here for dates & rates.

Note: Completing this form will reserve a spot for your child. A full registration packet will be mailed to you with the Medical and Trip Release forms.

Camper/Parent Information
Name
  First
Middle
Last
Age
Address
  Street
City
State
Zip
Date of Birth
   
Contact Info
   Home Phone
Email
 
Schools
  School

Finishing Grade:


Child's Mother
  Mother's Name
Hebrew Name
Work Phone
Cell
Child's Father
  Father's Name
Hebrew Name
Work Phone
Cell

Additional Information

 
 
Select T-Shirt Size   (Children sizes)

Small (6-8) Medium (10-12) Large (14-16) Extra Large

Adult Small Adult Medium

 
Select Child's Group
Finishing K-1      
Finishing 2nd-4th      
Finishing 5th -8th       
   
Please indicate which sessions your child will attend camp:
 

June 27th - July 1

IMPORTANT
  All forms and payments must be completed and submitted before your child begins camp.
 

I will be paying by: Check Credit Card
Please note: Paying by credit card will incur a 3% surcharge.
 

   
  Payment Information
 
Last Name   Total Charge  
First Name     Card Type  
Address   Card #  
City   Exp Date      
State     CVV Code  
Zip     Comments  
Email    

 

I have read the camp information and application details 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: