Lost Camp 2024 Application Form
Thank you so much for applying for this Life Changing Journey! 
Our program is absolutely transformational. 
And our guarantee to you is that your son is going to walk out a different person from this experience!
We are so excited about what we do!😊😊😊
Sign in to Google to save your progress. Learn more
Please Note:  

Please do not fill out this form unless you are already sure that you you are going to send your son to camp.

If you still have questions please message our amazing head of registration
Reuven Yona Ringo
(410) 205-0821 
reuven.trace24@gmail.com
(You do not need to sign into google to complete this form but it'll save your progress if you do).
Camper's First Name *
Camper's Last Name *
Camper's Phone # *
What stage are you at? *
Which trips are in interested in coming on?
*
Who is filling out this form? *
If you chose "other"-  please explain...
Marital Status
Mother's Phone # *
Father's Phone # *
Your Email Address *
References
We need to reach out to references to make sure this is a right fit.

Please Note: 
If the References are Waterbury Rabbeim there is no need to fill in their phone # just put in the name!
Reference #1- Name ( Camper's Rebbe/mentor) *
Reference's Phone #
Reference #2- Name  ( Camper's Rebbe/mentor) *
Reference's Phone #
Passport 

If your son is coming on the Peru trip he will need a valid passport. 
Does your son have a valid passport to use for the trip?
*
Please allow up to 2 days for us to get back you! 
We are going to just make sure with the references and your son that this is the right program for him and then we will be ready to go.
Thank you so much!
This is going to be so growthful for everyone!
Even you!
We're super excited!!🥳🥳😊😊
We're looking forward! 
Can't wait!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report