Yesh Winter Camp 2017 Application Form

VERY IMPORTANT – PLEASE NOTE:
. The information required in this form is of critical importance to the organizers and persons running Yesh for both the camps & activities throughout the year. All the information herein contained is for your child’s own benefit & should be completed meticulously & with care.
. The failure to supply all relevant and accurate information could have serious consequences for your child and other members of Yesh Camp SA.
. This application form applies to the camps and all activities run by Yesh Camp SA throughout the year, of whatsoever nature or kind.
. Incomplete forms or forms altered in any manner or way are unacceptable and will be rejected, preventing the organizers from accepting your child to the camps or any activities.
All information herein contained will be kept confidential.
Particular's of Camper
Please enter your FIRST NAME *
Your answer
Please enter your LAST NAME *
Your answer
Please enter your HOME NUMBER *
Your answer
Please enter your CELL NUMBER
Your answer
Please enter EMAIL ADDRESS at which we can contact you *
Your answer
Please enter your DATE OF BIRTH *
MM
/
DD
/
YYYY
Please enter your HOME ADDRESS
Your answer
Please enter your SCHOOL, if not in school fill in N/A *
Your answer
Please enter your GRADE *
If not in school, please fill in relevant information in other
PARTICULARS OF CAMPER’S PARENTS
FATHER'S NAME *
Your answer
FATHER'S OCCUPATION
Your answer
FATHER'S CELL *
Your answer
FATHER'S EMAIL *
Your answer
MOTHER'S NAME *
Your answer
MOTHER'S OCCUPATION
Your answer
MOTHER'S CELL *
Your answer
MOTHER'S EMAIL *
Your answer
In Case of Emergency 3rd Party Contact Name *
Your answer
3rd Party Contact Relationship *
Your answer
3rd Party Contact CELL *
Your answer
3rd Party Contact HOME *
Your answer
REFERENCES
List two references. Preferably, include your Rabbi and a teacher or principal.
REFERENCE ONE NAME *
Your answer
REFERENCE ONE CELL NUMBER *
Your answer
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