Wufoo

2009 Bnei Mitzvah Enrollment Application

July 13-19, 2009

Camper's Information
Camper's Name * First Last
Gender *
Date of Birth * MM / DD / YYYY
Grade in September, 2009 *

Camp Shomria's EcoCamp is available for teens ages 12-14.
Camper's School
Camper's Email
Referrals and Siblings

We offer hefty discounts and other opportunities for siblings and friends. List them here with their contact information and Share Shomria!
Parent 1 Contact Information

This parent will be the primary contact for the camp. If parents are separated or divorced, please fill in full both Parent 1 and Parent 2 sections.
Parent 1 Name * First Last
Parent 1 Email *

In an effort to be Green, most of our correspondence with you will be via email.
Home Phone Number * ### - ### - ####
Cell Phone Number * ### - ### - ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How did you hear about Camp Shomria?
Parent 2 Contact information

Although not required, this information is very useful in the event of an emergency or when Parent 1 can't be reached.
Parent 2 Name First Last
Parent 2 Email
Parent 2 Cell Phone Number ### - ### - ####
Discount and Scholarship Options

Please read our Tuition Discount and Scholarship Opportunities form for details.
You can always call us at (212) 627 2830 for details.
I have read Camp Shormia's Tuition Discount and Scholarship Opportunities form and have found that I am eligible for one or more tuition discounts. I would like to request a Camp Shomria Scholarship Application

If you are eligible for one or more tuition discounts, please indicate the specific discount(s) in the "Questions, Comments" field below.
A $500 deposit is required to complete enrollment.
Payment Options

To make things easy, we offer free payments plans. Call Tal Beery at (212) 627 2830 for details.
Your application is not complete until we have received the $500 deposit.
Please choose one *
A check is in the mail (made out to "Camp Shomria") I will pay online on www.HashomerHatzair.org I will call (212) 627 2830 with my credit card number.
Terms of Agreement
*
I have read and agree to the terms of agreement

Terms of Agreement
Questions or Comments?
Do Not Fill This Out

Wufoo

2009 Bnei Mitzvah Enrollment Application

Camper's Information

Parent 1 Contact Information

Parent 2 Contact information

Discount and Scholarship Options

A $500 deposit is required to complete enrollment.

Payment Options