Derech Eretz Summer Camp Registration Form
THIS REGISTRATION FORM MUST BE ACCOMPANIED BY A $50 DEPOSIT (WHICH WILL BE APPLIED TOWARDS CAMP FEES)
Camp Fees
Derech Eretz Camp: 2 weeks / $400 1 week / $240 (Kindergarten through 7th grade)
Adventure Camp: 2 weeks / $430 1 week / $260 (8th through 10th grades)
Camper Information
Camper 1 Name / Hebrew Name *
Your answer
Camper 1 DOB *
Your answer
Camper 1 Grade Fall '16 *
Your answer
Camper 1 Dates Attending: *
Required
Camper 1 T-Shirt Size *
Camper 2 Name / Hebrew Name
Your answer
Camper 2 DOB
Your answer
Camper 2 Grade Fall '16
Your answer
Camper 2 Dates Attending:
Camper 2 T-Shirt Size
Camper 3 Name / Hebrew Name
Your answer
Camper 3 DOB
Your answer
Camper 3 Grade Fall '16
Your answer
Camper 3 Dates Attending:
Camper 3 T-Shirt Size
Mother's Name
Your answer
Mother's Home Phone:
Your answer
Mother's Cell Phone:
Your answer
Mother's Work Phone:
Your answer
Father's Name:
Your answer
Father's Home Phone:
Your answer
Father's Cell Phone:
Your answer
Father's Work Phone:
Your answer
Home Address:
Your answer
Email Address: *
Your answer
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