CAMP YTT REGISTRATION FORM 2020-5780
Camp Fees: $6,180 (includes Airfare and registration fee)
Email address *
First Name(s) *
As it appears in your passport
Your answer
Middle Name
Your answer
Last Name *
As it appears in your passport
Your answer
Preferred Name *
Your answer
Hebrew Name *
Your answer
Mothers Hebrew Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Hebrew Birthday *
Your answer
Home Address, City & State *
Your answer
Name of School *
Your answer
Grade *
Principal's Name *
Your answer
Principal's Contact info *
Your answer
Campers Email Address *
Your answer
Home Phone Number *
Your answer
Campers Cell Phone Number *
Your answer
Anything we should know about your daughter? *
Your answer
Fathers Name *
Your answer
Father's Cell Phone Number *
Your answer
Father's Email Address *
Your answer
Father's Marital Status *
Mothers Name *
Your answer
Mother's Cell Phone Number *
Your answer
Mother's Email Address *
Your answer
Mother's Marital Status *
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Relationship to camper *
Your answer
Rate Your Level of Tznius *
From 1 to 10
Your answer
Your Level of Chassidishkeit *
From 1 to 10
Your answer
What are your special strengths or talents? *
Your answer
Tee shirt size, to fit loosely *
Choose from drop-down list below
Write a paragraph describing why you want to go to Camp YTT *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Chabad's Children of Chernobyl. Report Abuse