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Register Online

Register Online

Online Registration

Please fill out the registration form below carefully.  There is a section for each camper (child) you are registering.  Click here for information on the rates. When you press submit, this form will be sent to our office for processing.  Note: this form is secure using 128 bit SSL encryption for your privacy and protection. 

Registration is open to children entering K-8 

Camper # 1

Name

 

First
 

  Last

 Grade Entering

 

Date of Birth
   

 Gender

Male      Female
            

Hebrew Name

 

if applicable

Hebrew School

if applicable

Week(s)

 

                                     1  (July 8-12)     2 (July 15-19)          
5 Days / Week                                    

 
 

 

Camper # 2

Name

 

First
 

  Last

 Grade Entering

 

Date of Birth
   

 Gender

Male      Female
            

Hebrew Name

  if applicable

Hebrew School

if applicable

Week(s)

 

                                       1  (July 8-12)     2 (July 15-19)          
5 Days / Week                                     

 
 

 

Camper # 3

Name

 

First
 

  Last

 Grade Entering

 

 
Date of Birth
   

 Gender

Male      Female
                 

Hebrew Name

  if applicable

Hebrew School

if applicable

Week(s)

 

                                    1  (July 8-12)     2 (July 15-19)          
5 Days / Week                                     

 
    

 

Parent Information

 Mother

 

 First
 

Last

Cell Phone  

Father

  First
 

Last

Cell Phone

Synagogue
Affiliation

 
if applicable
     
Address
  Street
City State
Zip
Contact Info
  Home Phone
Email
 

 

Payment Info
                                                  First                                           Last
Name (on credit card)      
Credit Card Number

 

Expire Date      Amount $

Enter amount to be charged.  This should be $50 per child per week to reserve your spot (minimum) or a larger amount up to the full camp fees. If you do not pay in full now, you will be billed the difference.  Click here for the camp rates (opens in a new window, so you won't lose your data).

Refer a friend and receive 5% off your tuition.  Click here for more info (opens in a new window, so you won't lose your data).

 

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