Winter Camp | The Shul Hebrew School

Winter camp4.jpg

Parent Info.

Father's Name:                       Phone:                             Email:

Mother's Name:                      Phone:                             Email:

Address:

Child Info.

Child #1
Name: Age:

Child #2
Name: Age:

Days Attending, All Days 1 2 3 4

In case of emergency please contact:
Name: Phone:
Relationship to camper:

Specific Health / or other notes (if applicable):

Doctor's Name: Phone:

Payment Info:

Total amount to charge card:
Method of Payment: Visa Amex MC. - Zip:
Credit Card # Exp Date:

I authorize Youth Zone Winter Experience, in case of emergency, to have my child/ren cared for by a physician in the manner the situation should call for. I further permit for my child/ren to be transported on all trips during the winter camp.

This page uses 128 bit SSL encryption to keep your data secure.