Online Registration

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.
A completed
health form must be submitted before camp begins.

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
2 years old
5 Years Old  
3 years old
6 Years Old  
4 years old
7 years old  
Please indicate the number of week your child will attend camp:
 
Please choose week/s:

Week 1 : July 13 
Week 2 : July 20
Week 3 : July 27 
Week 4 : August 3 
Week 5 : August 10 
Week 6 : August 17

IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Check Credit Card
I have read the 2020 summer camp guidelines handbook and agree to the terms stated. I give my child permission to attend all activities receive medical care in the case of emergency.
   
  Date of Application: