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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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 - July 3 Week 2 - July 7 Week 3 - July 17 Week 4 - July 24 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 - July 3 Week 2 - July 10 Week 3 - July 17 Week 4 - July 24 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 - July 3 Week 2 - July 10 Week 3 - July 17 Week 4 - July 24 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 Quantity* Price: $195.00 Quantity Early Bird weekly at $175/each Quantity Price: $175.00 Quantity Weekly TEEN Tuitions at $260 each (week 1-3 only) Quantity Price: $260.00 Quantity Weekly Early Bird TEEN Tuitions at $230 each (week 1-3 only) Quantity Price: $230.00 Quantity Weekly Lunches at $15/per week Quantity* Price: $15.00 Quantity Weeks of Morning Extended Care at $25 each Quantity Price: $25.00 Quantity Weeks of Afternoon Extended Care at $25/each Quantity Price: $25.00 Quantity Camp Hat and T-Shirt Sets at $15 Quantity* Price: $15.00 Quantity Extra T-Shirts at $15 Quantity* 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 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. 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