Camp Kesher Channie application
To be completed by parents / guardians ONLY –NOT by campers!
Please note:
Information disclosed in this document is confidential (information shared in this document will
be safeguarded, refrained from sharing without a justified reason) specifically by the committee of
camp, with the inclusion of the Heads of camp.
However, partial confidentiality (some information will have to be shared to protect the wellbeing of your child) will be maintained as specific details (medical information) will be disclosed to
the tent advisor/s of your child. Tent advisors will be liable to a non-disclosure clause to protect
the privileged content in this document.
However please note, confidentiality between advisors on camp is limited in the case of:
1) Harm to your child.
2) Harm to another child.
3) Communicable illnesses.
Please be mindful to include all relevant information pertaining to your child’s well-being. It is
crucial that the heads of the camp are well informed.
Camper Basic Details
To Be filled out as they appear on the identification document or Birth certificate
Camper’s First Names *
Your answer
Camper Surname *
Your answer
Camper cell number
Your answer
ID Number *
Your answer
Sex *
Age *
Your answer
Mothers First Name *
Your answer
Mothers Surname *
Your answer
Was the campers mother born Jewish? *
Mothers Maiden Name *
Your answer
Mothers Cell Number *
Your answer
Mothers email address *
Your answer
Fathers first Name *
Your answer
Fathers Surname *
Your answer
Was the campers father born Jewish?
Fathers Cell Number *
Your answer
Fathers email address *
Your answer
If either parents or the child were converted, when, where and at which Rabbinical Court?
Your answer
Synagogue where parents married
Your answer
Date of Marriage
MM
/
DD
/
YYYY
If divorced or separated, when?
Your answer
If divorced or separated, do both parents consent to child’s attendance of Camp Kesher
Your answer
Name & Contact Number in case of emergency:
Your answer
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