Online Registration experience the summer of your lifetime We will send out an acceptance letter and invoice shortly after we receive your registration. Family InformationHow many children are you registering today?* 1 2 3 Family Name* Family Name Address* Street Address Line 2 City State Zip CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Mother Mother's Name Hebrew Name Work PhoneCellFather Father's Name Hebrew Name Work PhoneCellEmergency Contact Info PhoneRelationship Emergency Contact Info PhoneRelationship Pediatrician PhoneCamper 1 InformationName* First Name Last Name Gender* Male Female Date of Birth* MM slash DD slash YYYY School Entering Grade Quick Health Notes Allergies Health Problems or Disabilities T-shirt Size*select oneS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2X(A) implies adult sizesAge Group* Younger Div (Ages 3-9) VIP's (Age 7-9) Pioneers (Ages 10-12) C.I.T's (Ages 13-16) (Week 1-3 only) Sessions Attending & Additional Requirements* Full Session Week 1 - June 27 Week 2 - July 4 Week 3 - July 11 Week 4 - July 18 Yes, I will need Before Care 8:00-9:00 am Yes, I will need After Care 3:30-5:00 pm Camper 2 InformationName* First Name Last Name Gender* Male Female Date of Birth* MM slash DD slash YYYY School Entering Grade Quick Health Notes Allergies Health Problems or Disabilities T-shirt Size*select oneS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2X(A) implies adult sizesAge Group* Younger Div (Ages 3-9) VIP's (Age 7-9) Pioneers (Ages 10-11) C.I.T's (Ages 12-15) (Week 1-3 only) Sessions Attending & Additional Requirements* Full Session Week 1 - June 27 Week 2 - July 4 Week 3 - July 11 Week 4 - July 18 Yes, I will need Before Care 8:00-9:00 am Yes, I will need After Care 3:30-5:00 pm Camper 3 InformationName* First Name Last Name Gender* Male Female Date of Birth* MM slash DD slash YYYY School Entering Grade Quick Health Notes Allergies Health Problems or Disabilities T-shirt Size*select oneS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2X(A) implies adult sizesAge Group* Younger Div (Ages 3-9) VIP's (Age 7-9) Pioneers (Ages 10-11) C.I.T's (Ages 12-15) (Week 1-3 only) Sessions Attending & Additional Requirements* Full Session Week 1 - June 27 Week 2 - July 4 Week 3 - July 11 Week 4 - July 18 Yes, I will need Before Care 8:00-9:00 am Yes, I will need After Care 3:30-5:00 pm Payment InformationWeekly Tuitions at $195 each* Price: $195.00 Quantity: Early Bird weekly at $175/each Price: $175.00 Quantity: Weekly TEEN Tuitions at $260 each (week 1-3 only) Price: $260.00 Quantity: Weekly Early Bird TEEN Tuitions at $230 each (week 1-3 only) Price: $230.00 Quantity: Weekly Lunches at $15/per week* Price: $15.00 Quantity: Weeks of Morning Extended Care at $25 each Price: $25.00 Quantity: Weeks of Afternoon Extended Care at $25/each Price: $25.00 Quantity: Camp Hat and T-Shirt Sets at $15* Price: $15.00 Quantity: Extra T-Shirts at $15* Price: $15.00 Quantity: Extra Shirt Sizing Total Amount $0.00 Payment Method*I will send a check by June 10th (April 30 for early-bird)Please charge my card the above total.Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. Δ