Winter Camp Registration

Address*

Birth Date*

Month Day Year
School*
Current Grade*
Parent's Information
Parent 1 Name*

First Name Last Name
Parent 1 Title*
Parent 1 Cell Phone*
Parent 1 E-mail*
Parent 2 Name

First Name Last Name
Parent 1 Title
Parent 2 E-mail
Parent 2 Cell Phone
Emergency Contact
Emergency Contact Name*

First Name Last Name
Emergency Contact Phone Number*
Relationship to child*
Name of Physician*

First Name Last Name
Physician Phone Number*
References

Please list 2 references and their contact info.

Examples:
Current or recent teacher, principal, camp director
Reference 1 Full Name*

First Name Last Name
Reference 1 relationship*
Reference 1 Phone Number*
Reference 2 Full Name*

First Name Last Name
Reference 2 relationship*
Reference 2 Phone Number*
Payment Info
Winter Camp Tuition is $600 for the residential one week program. This helps cover the cost of lodging, 3 hot meals a day, all activities and trips and transportation.

Full payment with application reserves your child’s spot.
Tuition cost* Please choose the full cost or the early bird discount price

$500$600
Total

$0.00

Payment

Credit Card Paypal Other: Zelle, PayPal, Check/Cash

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New York's Best Jewish Camp