Summer Camp Application

    Camper General Information

    First Name
    Last Name
    Hebrew Name
    Gender
    Date of Birth
    Age
    Place of Birth
    Languages Spoken
    Address
    City
    State
    Zip
    Phone
    Cell Phone
    Synagogue Affiliation

    Family Information

    Parent/Guardian A

    First Name
    Last Name
    Address (if different than above)
    City
    State
    Zip
    Home Phone
    Work Phone
    Cell Phone
    Occupation
    Business Address
    Email
    Title of Position
    Country of Origin
    Jewish?

    Parent/Guardian B

    First Name
    Last Name
    Address (if different than above)
    City
    State
    Zip
    Home Phone
    Work Phone
    Cell Phone
    Occupation
    Business Address
    Email
    Title of Position
    Country of Origin
    Jewish?
    Conversions/adoptions in the family
    If yes, please specify
    Send Correspondence to
    Child's parents are
    Do Parents share legal custody?
    Do Parents share physical custody?
    Name of Step-parent/s
    Siblings of Applicant
    Name
    Date of Birth
    Current School
    Name
    Date of Birth
    Current School
    Name
    Date of Birth
    Current School

    School Child Currently Attends

    Name of School
    Dates of Attendance
    School Phone Number
    School Contact Person
    Name of School
    Dates of Attendance
    School Phone Number
    School Contact Person

    Application Details

    Personal References

    Name
    Phone
    Name
    Phone