CHILD'S INFO
Name
Hebrew Name
Gender
Male
Female
Birthdate
MOTHER'S INFO
Name
Hebrew Name
Occupation
Cell Phone
Email
FATHER'S INFO
Name
Hebrew Name
Occupation
Cell Phone
Email
CONTACT INFO
Home Phone
Address
City
State
Zip
FAMILY INFO
Is the Mother of the child Jewish? *
Yes
No
Is the Father of child Jewish? *
Yes
No
Are there any conversions in the family? *
Yes
No
Does the child live with both natural parents? *
Yes
No
Marital Status of Parents *
PROGRAM SELECTION
* All children must be fully toilet trained before camp begins.
Program
Full Name
How did you hear about us? *
Submit Application
This site is protected by reCAPTCHA and the Google
Privacy Policy
and
Terms of Service
apply.
This page uses SSL encryption to keep your data secure.
This page uses SSL encryption to keep your data secure. This page uses SSL encryption to keep your data secure.