Register using the online form.
First Name: Last Name: Gender: MaleFemale
Home Phone: Camper's Email:
Address: City, Province/State: Country:
Date of Birth: 12345678910111213141516171819202122232425262728293031 (Day) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember (Month) (Year)
Camper Primarily Lives with: Both parents in one homeBoth parents in different homesParent oneParent twoLegal GuardianOther -- If other:
Name of School: Grade Completed: 123456789101112
Current Swimming Level: Adult T-Shirt Size: SmallMediumLargeX-Large
Is English your first language? YesNo -- If no, what is?
Has an Individual Education Plan (IEP) or something similar? YesNo
Gesher group from previous summer: N/AOfarim (2/3)Amelim (4)Chalutzim (5)Solelim (6)Chotrim (7)Bonim (8)MBI (10)
Session from previous summer: N/AFull Session1st Session2nd SessionMadatzOfarim AlephOfarim FullOfarim Bet
Session for this summer: Full Session1st Session2nd SessionMadatzOfarim AlephOfarim FullOfarim Bet
Previous camps and other experience:
E-mail: Cell Phone:
City, Province/State: Country:
Street Address: Zip/Postal Code:
Person 1 Name:
Relation to Camper:
Person 2 Name:
Will the camper require a special diet? NoVegetarianLactose IntolerantPeanut AllergyOther -- If other:
Will the camper be restricted from participating in any activities? YesNo -- If yes, explain:
Is there anything else we should be aware of?