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Camp S'dei Chemed international 1849 east 38th street brooklyn ny 11234

Tel. # 001-718 -633 -1909 / Fax#001-718 -435 - 0191

CAMPER APPLICATION FORM BOYS AND GIRLS

Make sure to send in a hard copy with deposit and picture ASAP

Todays Date:

Campers full name:Phone #:
Address: City: State: Zip:
Nationality: Place of Birth: Email Address:
Age: (as of this coming june) Date of Birth: (M/D/Y)
Fathers Name: Occupation:
Firm Name:
Mothers Name: Occupation:
 

I would like my child to participate in:

If for any reason you will be making your own air arrangements,
please note here:

Name on Passport       Passport Number

Present School Attending: Grade (Hebrew)(Secular)
General Class Work Excellent Very Good Good Fair Weak
School Conduct  Excellent Very Good Good Fair Weak
Other Schools previously attended:

Friends, with whom you'd like to bunk (if same age)

List and describe briefly, skills, hobbies, interests, including Jewish activities and general groups (music, sports, clubs, etc.)

Have you ever attended sleep-away camp?Yes No
Camps previously attended
How did you find out about our program?

REFERENCES: List 2 references.
Preferably, include your Rabbi and a school teacher or principal.

NAME               ADDRESS             TELEPHONE                  PROFESSION

PLEASE NOTE: The program allows for three free days plus one weekend whereby boys are given the opportunity to visit relatives or friends in Israel. Boys who do not elect to use these free days are given a special touring program under full supervision. Parents giving their son permission to go out assume all responsibility for that day.

  FREE DAY INSTRUCTIONS:
I allow my child to go out on his own on the free days.
I allow my child to go out only if picked up by relatives or family friends.
I do not permit my son to leave on free days except with camp tour.

Special Medical Instructions?
Signature of Parent or Guardian

Application will not be admitted until a $500 deposit (fully refundable up to 6 weeks before departure) & a photo are sent in to above address.

Any Additional comments please fill in here

Please Note: We only accept boys who are well mannered and have a good behavior record!

 
Web Design by: Dovid Teitelbaum
This site is a project of Camp S'dei Chemed International
for more information come visit our web page.
or Email us at info@campsci.com .
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