Camp Application
Bachur information
First Name
*
Last Name
*
Date of Birth
*
Age
*
Current Yeshiva
*
This Year's Rebbi
*
Rebbi's Phone Number
*
Menahel
*
Menahel Phone Number
*
Previous Camp(s) Attended
2024
*
2023
2022
Friends applying with:
1
*
2
3
Parents’ information
Father's Name
*
Father's Cell Number
*
Father's Email address
*
Mother's Name
*
Mother's Maiden Name
*
Mother's Cell Number
*
Mother's Email address
*
both parents would like to receive camp emails
Marital Status
Address
*
City
*
State / Province
*
Zip / Postal
*
Home Phone Number
*
Emergency Contact Name
*
Emergency Contact Number
*
Relation
*
Is the bachur taking medications?
*
Yes
No
List names of all medications
Does the bachur have any food allergy?
*
Yes
No
List any food allergies
Other Important Notes
I agree to submit a $750 deposit as part of the application process. (If my child is not accepted, the deposit will be fully refunded.)
I would like to apply for the full 3 week program
Parent Signature
*
Clear
Submit
