Camp Sheves Achim Application Summer 2019
PLEASE FILL OUT ONE FORM PER CHILD. Early bird deadline - April 30 2019
Email address *
Child's Full Name *
Your answer
Child's Hebrew Name *
Your answer
Current Grade *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Father's Name *
Your answer
Father's Daytime Phone Number *
Your answer
Father's Email Address *
Your answer
Mother's Name *
Your answer
Mother's Daytime Phone Number *
Your answer
Mother's Email Address *
Your answer
Emergency Contact *
For your child's safety, please include name, address, and all phone numbers of someone other than a parent in case of an emergency.
Your answer
Child's Physician In Case Of Emergency (Name And Phone Number) *
Your answer
Please List Any Known Allergies:
Please include any helpful information for dealing with potential hazards and reactions
Your answer
One time registration fee of $35 required at the time of enrollment per child. This helps cover the cost of your child's camp t-shirt and initial camp fee.
Please select your child's t-shirt size:
Early Bird Registration: $275 per session or all 3 sessions for $800. Standard Registration: $300 per session or all 3 sessions for $875 *
Required
Signature: *
Submitting parent's/guardian's name below constitutes a binding digital signature.
Your answer
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