Online Application!

For Camp Rates click here

To register, please fill out carefully.  There is a $35 - $100 non-refundable registration fee. (See Camp Rates)

You can also register by printing out our Camp Registration PDF and sending along with check. Click here for the Camp Forms Page.

When you press submit, this form will be sent to our administration office.
Please look out for our letter of acceptance. You will only be charged the registration fee once accepted.

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
   
           
Select Child's Age Group
Ages 10-13
Ages 3-5  
Ages 5-9
 
    
 
  
Please indicate the weeks your child will attend camp (N/A For Winter Camp):

 

 Week 1       Week 2     Week 3     Week 4
     
IMPORTANT
•
 All forms must be completed and submitted before your child begins camp.
  With the submission of this form I am paying for: Only Regisration Fee  Partial Tuition & Registration Fee  Full Tuition & Registration Fee
•
 I will be paying by: Check Mastercard Visa Amex

Card Number

   Expiration Date
Cardholder
Name
  Total Amount 
I have read the parent handbook, 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: