Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Please use a separate form for each child. Click here for dates & rates.

Note: Completing this form will reserve a spot for your child.

A full registration packet will be mailed to you with the Medical Release forms.

Camper/Parent Information
Name
   First
Middle
Last
Age
Address
   Street
City
State
Zip
Date of Birth
    
Contact Info
   Home Phone
Email
 
Schools
   School

Finishing Grade:


Child's Mother
   Mother's Name
Hebrew Name
Work Phone
Cell
Child's Father
   Father's Name
Hebrew Name
Work Phone
Cell

Additional Information

  
 
Select T-Shirt Size (Children sizes)

Small (6-8) Medium (10-12) Large (14-16) Extra Large

Adult Small Adult Medium
 
Select Child's Group
Finishing K-1    

 
Finishing 2nd-4th      
Finishing 5th -7th      
Mini Gan Izzy - 2 - 5 Years
Please indicate which sessions your child will attend camp:
 

Session 1: June 30 - July 3

Session 2: July 7 - July 11

Session 3: July 14 - July 18 (Mini Gan ONLY)

Session 4: July 21 - July 25 (Mini Gan ONLY)
 

$35 Mandatory Registration Fee – Includes T-Shirt

Register by May 8th and receive a 10% early bird discount, on the weekly tuition.
IMPORTANT
  All forms and payments must be completed and submitted before your child begins camp.
 

I will be paying by: Check Credit Card
Please note: Paying by credit card will incur a 3% surcharge.

   
  Payment Information
 
Last Name   Total Charge
First Name   Card Type
Address   Card #
City   Exp Date
State   CVV Code
Zip   Comments
Email    
I have read the camp information and application details 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: