Wufoo

Camp Shomria 2009 Enrollment Application

Camper's Information
Camper's Name * First Last
Gender *
Date of Birth * MM / DD / YYYY
Grade in September, 2009 *
Camper's School
Camper's Email
Camper's T-Shirt Size
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 ### - ### - ####
Transportation Information

Transportation to camp is free from four convenient locations - Manhattan, Long Island, New Jersey, and Albany - on June 28. We also offer transportation back from Shomria at the end of Second Session on August 9. Please see our website or call us at (877) SHOMRIA for location details.
My child will travel by bus from: *
Program Options

This summer we have many options for you and your children to choose from.
Camp Shomria
First Session - June 28 to July 19 - $2720 Second Session - July 19 to August 9 - $2655 Full Summer - June 28 to August 9 - $3995

Our traditional program, for ages 9-15, is the best!
Machane Kahol Lavan
First Session - June 28 to July 5 - $795 Second Session - July 5 to July 11 - $795 Full Session - June 28 to July 11 - $1590

This is our special camp for children between the ages of 8-12. With a strong focus on group-building and informal Hebrew instruction, it is a great introduction to camp. Stay for one or two weeks.
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.
My child is new camper, and I would like to request information about the Campership Incentive Grants in my area (they go as high as $1,800!) 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.
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 $750 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

Camp Shomria 2009 Enrollment Application

Camper's Information

Parent 1 Contact Information

Parent 2 Contact information

Transportation Information

Program Options

Discount and Scholarship Options

Payment Options