Online Registration!

You MUST download, Print, Complete and Return the forms. (The online form below is to reserve your child's spot). A signed hard copy of all forms must be turned in before your child could attend.

Please click here to download Registration Packet

Camp Fee $180 Per week - Includes all activities trips! 

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  Gender
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
Ages 11/12
 
    
Ages 6-10      
Ages 4-6
Please indicate which session(s) your child will attend camp:
 
     
IMPORTANT
•
All forms must be completed and submitted before your child begins camp.
•
I will be paying by: Check Mastercard Visa   American Express
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: