Hashomer Hatzair

Camper's Information
Camper's Name * First Last
Gender *
Date of Birth * MM / DD / YYYY
Grade in September, 2010 *
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!
Insurance Cards

If your child has attended a major peula in the past (Peulat Stav, Mosh Choref/Kayitz, Lag Ba'Omer), your insurance has not changed and we have a copy of your card, please check the "Yes" box.
If your child is a first-time camper, or if your insurance has changed, please check the "No" box and send in a copy of your child's current insurance card. Please send in a copy to mail@hashomerhatzair.org or 114 West 26th St. NY, NY 10001
*
Yes - HH has a current copy of insurance No - HH does not have a current copy of insurance and I will SEND one in
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 provided from four convenient locations - Manhattan, Philly, New Jersey, and Albany - on July 3. We also offer transportation back from Shomria at the end of Second Session on August 14.
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: July 3rd - July 24th - $2,995 Second Session: July 24th - August 14th -$2,495 Full summer: July 3rd - August 14th - $4,295
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!)

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 Shaked Angel 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.

Please note that an additional 3% processing fee will be applied to all payments made via credit card.
Terms of Agreement
*
I have read and agree to the terms of agreement

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

Hashomer Hatzair

Camper's Information

Insurance Cards

Parent 1 Contact Information

Parent 2 Contact information

Transportation Information

Program Options

Payment Options