Online Registration!

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

Early Bird Discount for registrations before May 1.  

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
Ages 10-12
Ages 3-4  
Ages 4-9
Ages 2-3  
 
  
Please indicate number of sessions your child will attend camp:
 
     
IMPORTANT
•
All forms must be completed and submitted before your child begins camp.
•
I will be paying by: Check Mastercard Visa
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: