Camper Application

CAMPER APPLICATION FORM

Program

Todays Date:

Campers full name:Phone #:
Parents Cell Childs Cell
Address: City: State: Zip:
Nationality: Place of Birth: Parents Email : Child Email
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 Passport Exp.

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 child to leave on free days except with camp tour.

Special Medical Instructions?
Signature of Parent or Guardian

Any Additional comments please fill in here

Please Note: We only accept campers who are well mannered and have a good behavior record!
Application will not be finalized until a $500 deposit (fully refundable up to 6 weeks before departure) & a photo are submitted.

Camp S'dei Chemed on Facebook

Girls Program
[Contact Us]

CAMPER APPLICATION FORM

Program

Todays Date:

Campers full name:Phone #:
Parents Cell Childs Cell
Address: City: State: Zip:
Nationality: Place of Birth: Parents Email : Child Email
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 Passport Exp.

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

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 child to leave on free days except with camp tour.

Special Medical Instructions?
Signature of Parent or Guardian

Any Additional comments please fill in here

Please Note: We only accept campers who are well mannered and have a good behavior record!
Application will not be finalized until a $500 deposit (fully refundable up to 6 weeks before departure) & a photo are submitted.

CAMPER APPLICATION FORM

Program

Sdei Chemed Girls Sdei Chemed Boys

Todays Date:

Campers full name:Phone #: Parents Cell Childs Cell Address: City: State: Zip: Nationality: Place of Birth: Parents Email : Child Email 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: Tour A "Grand tour of Israel" Tour B "Off the beaten path"

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

Name on Passport Passport Number Passport Exp.

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: