Camp Yavneh CIT Application Summer 2018
Camper Last Name *
Your answer
Camper First Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone Number *
Your answer
Camper Cell Number(If they have one)
Your answer
Camper Email Address *
Your answer
Weeks applying for *
Required
T- Shirt Size *
Required
Parent Name *
Your answer
Parent Email *
Your answer
Parent Cell Phone Number *
Your answer
Primary Doctor *
Your answer
Medical Insurance Company and Plan Number *
Your answer
Please write a paragraph about why you want to be a CIT *
Your answer
Which Age Do you think you would work best with? *
Required
Please list 2 references with contact info of people you have worked with/for (Ex: Babysitting, Synagogue, teachers, employers) *
Your answer
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