Register!

3. We will contact you if you are accepted. Proceed by sending your payment and medical forms. If you are requesting a scholarship, you may send the scholarship and medical forms and send payment after you have been awarded the scholarship.

4. Sometime before camp, look through the creative club choices with your daughter and have her submit her preferences.

We look forward to meeting your daughter!

* Required fields
Name *
E-mail Address *
Girl's Name *
Girl's Hebrew Name
Date of Birth *
Hebrew date of birth:
Girl's Social Security #: *
Girl's E-mail address
School *
School Phone *
Grade completing as of June: *
Hebrew School or Bat Mitzvah Club
Rabbi/Club Leader's Name
Reference Name *
Reference Phone Number *
Address *
City *
State *
Zipcode *
Home Phone Number *
Summer Address (if different from above):
Father's First Name *
Father's Last Name *
Place of Business
Work Phone
Cell Phone *
E-mail *
(Needed for hospital insurance): Social Security Number *
(Needed for hospital insurance): Date of Birth *
Mother's First Name *
Mother's Last Name *
Place of Business
Work Phone
Cell Phone *
E-mail *
(Needed for hospital insurance): Social Security Number *
(Needed for hospital insurance): Date of Birth *
Which camp did you attend last year?
How did you hear about the retreat? *
T-shirt Size: *
Med. Insurance Co. Policy # *
Bunkmate Request(s) - must be same age
Please describe your child and tell us anything that might be helpful to know about her:
Applicant's Hobbies:
How would you like to see your child GROW at the Jewish Girls Retreat?
Your comments or program suggestions:
Does your child have any allergies or other medical conditions? *
If yes, please specify:
My daughter will attend: *	Full Camp Session (3 weeks) Week 1 Week 2 Week 3 Other
If other please specify:

I have read and agree to the Privacy Policy *

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