Wufoo

Lag Ba'Omer Spring Camp 2009

Registration Form - May 29-31, 2009

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

Please include your child's grade as it will be NEXT SCHOOL YEAR, in September 2009.
Camper's School
Dietary considerations - please list here any allergies or special food limitations. If more space is required, please use the "question/comment" section at the end of this form.
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 ### - ### - ####
Transportation Information

We provide transportation from four convenient locations in Manhattan, Long Island, New Jersey, and Albany.
From where will your child be travelling? *
Full payment and a photocopy of the front and back of your health insurance card is required to complete enrollment.

Fax us at (212) 989 9840, or mail checks to Camp Shomria / 114 West 26th St. Suite 1001 / New York, NY 10001
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

Lag Ba'Omer Spring Camp 2009

Camper's Information

Parent 1 Contact Information

Parent 2 Contact information

Transportation Information

Full payment and a photocopy of the front and back of your health insurance card is required to complete enrollment.