Camper Info

First Name:

Last Name:

Phone:

Cell Phone:

Email:

Address:

City:

State:

Zip:

Gender:

Date of birth:

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Family Information

Father's Name:

Mother's Hebrew Name:

Mother's Last Name:

Grandmother's Hebrew Name:

In Emergency Contact:

Emergency Phone Number:

Referred to this camp by:

Contact Phone Number:

Other friends attending

Choose a Session

Girl's DU Sessions

Session A: June 26 - July 14, 2019

Session B: July 30 - August 18, 2019

Girl's Internship Sessions

TBA

Boy's DU Sessions

Session A: Aug 2nd -Aug 15th 2019

Session B: Aug 16 - Aug 29 2019

Boy's Internship Sessions

TBA

History

Schooling History

Year graduated high school:

School(s) & years attended:

Are you currently employed?

Camp History

Camp names and summers attended:

Medical History (All information will be kept strictly confidential)

Allergies

Medications

Reason for taking medications

Please list any history of anxiety, depression, and eating disorders

Future Plans

What are your plans for next year?

Work :

Yes No

College/Seminary:

Yes No

If yes, which school?

Other Plans: Please specify

References

As standard process, please list 2 names and numbers of teachers/principal who currently know you well.

Reference 1

Name

Phone

Relationship

Reference 2

Name

Phone

Relationship

Are you returning from Israel?

Yes No

For information on our Summer Food Program participation and policies, please see the forms section of our website

Application Process

Apply

Review

Contact

If you're a returning camper & know your reference number, please apply here.

Application Form

Camper Info

Family Information

Choose a Session

Girl's DU Sessions

Girl's Internship Sessions

Boy's DU Sessions

Boy's Internship Sessions

History

Future Plans

Religious Background

References

Reference 1

Reference 2

Payment