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Winter Camp

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 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
Please write your Child's age
 
   
 
 
 
   
 
 
Please indicate number of sessions your child will attend camp:

Camp dates: Monday, Dec. 26- Friday Dec. 30

The price of camp includes a hot lunch
Monday, Dec. 26 Tuesday, Dec. 27Wednesday, Dec. 28Thursday, Dec. 29

Friday, Dec. 30

     
Please Purchase Camp Logo SweatShirt: $10 each

Each camper needs to have at least one

Select Size

     
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Credit Card
  Name on Card
 

Credit Card Number

Exp CVV Code

Total amount to charge to card

These fees will only be charged upon acceptance of your child

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:

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