Winter Camp 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  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    

 

       

 

        
Cost 
    $280 for the week $60 per day
              
 
 Hot Lunch included  
 
 
Please indicate the days your child will attend camp:
 

Monday (December 26, 2022)
Tuesday (December 27, 2022)
Wednesday (December 28, 2022)
Thursday   (December 29, 2022)
Friday (December 30, 2022)
 Whole Week

 

   

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: