Summer Camp Registration Form

Full Name*

First Name Last Name

Jewish Name*

Gender*

MaleFemale

Birth Date*

Month Day Year

Time of Day*

Grade Entering*

School*

Child's Cell

Child's Email

Which camp's have they gone to in the past the past?

Camp Weeks*

Child Lives With

Both ParentsMotherFather

Mother

SingleMarried to FatherMarried to Other

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Cell Phone

Work Phone

E-mail

Jewish?

By BirthNot JewishConverted (Please provide documentation)

Occupation

Father

SingleMarried to MotherMarried to Other

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Cell Phone

Work Phone

E-mail

Jewish?

By BirthNot JewishConverted (Please provide documentation)

Occupation

Which way will you commit to respond to?

Registration Policy: A completed application must be submitted with a non-refundable fee of $75.00 per camper, not credited toward total tuition fees. Please only register your child once you are certain they will be attending, as holding a spot affects other families who are eager to enroll.

No refunds will be given for any withdrawals and/or incomplete attendance.
A $35 fee will be charged for returned checks.

Non-Refundable Registration Fee (Please don't register until you're 100% sure they will come)

Due at Registration

$75$125/Family

Camp Tuition (Includes Breakfast, Hot Lunch & Snack)

$375/ Weekly

Summer Camp Registration Form

Camper's Information

Parent's Information

Mother

Father

Communication

Fees