Valley Beth Shalom Early Childhood Center
October 19th-21st
Adult Information
Adult #1 First Name *
Your answer
Adult #1 Last Name *
Your answer
Adult #1 Email *
Your answer
Adult #1 Cell phone *
Your answer
Adult #2 First Name
Your answer
Adult #2 Last Name
Your answer
Adult #2 Email
Your answer
Adult #2 Cell Phone
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Child Information
Child #1 Name *
Your answer
Child #1 Date of Birth *
MM
/
DD
/
YYYY
Child #1 Gender *
Child #1 Classroom *
If 1st grade or above, what grade is your child?
Your answer
Child #2 Name
Your answer
Child #2 Date of Birth
MM
/
DD
/
YYYY
Child #2 Gender
Child #2 Classroom
If 1st grade or above, what grade is your child?
Your answer
Child #3 Name
Your answer
Child #3 Date of Birth
MM
/
DD
/
YYYY
Child #3 Gender
Child #3 Classroom
If 1st grade or above, what grade is your child?
Your answer
Child #4 Name
Your answer
Child #4 Date of Birth
MM
/
DD
/
YYYY
Child #4 Gender
Child #4 Classroom
If 1st grade or above, what grade is your child?
Your answer
Guest Details
The Jewish Federation of Los Angeles is generously providing financial aid. Will your family be requesting aid? (Please see Abby Mars for more information.) *
Dependent on adequate registration, children 1st grade and older can sleep in the bunks with Camp Ramah counselors. Please list the name and grade of any child who would like to sleep in the bunks, if possible.
Your answer
Will you need a port-a-crib? Please note this is based on availability *
Do we have your permission to include your name and phone number on a roster of family camp participants? *
Does anyone in your family have dietary restrictions? (Vegetarian, gluten-free, dairy-free, other) Please note: Camp Ramah is a nut-free environment.
Your answer
Is there any other information that you feel we should know to help us provide your family with the best Camp Ramah experience possible?
Your answer
Thank you for registering, our Camp Ramah office will be in touch with you about payment.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service