Teen Information |
First Name (shown on ID)*
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Gender*
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Current Grade*
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On a scale from 1 to 10, how adventurous are you?
5 6 7 8 9 10
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Parent Information |
Address*
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Marital Status*
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Father's Name |
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Mother's Name |
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NOTE: We accept conversions recognized by the rabbinical courts in Israel (Rabanut of Israel). |
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Health & Transportation |
Emergency Contact Information |
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Physician or Medical Facility
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Phone
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Parental Consent and Transportation Information |
I hereby give my consent for emergency medical treatment, to be used only if I cannot be reached immediately. |
Initialize*
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I hereby give permission for my child to be transported and participate in field trips during operating hours. Details will be sent to me in advance |
Initialize*
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Health History and Special Instructions |
List any illnesses your child had within past 6 months
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List any Sensitivities your child has. Any dislikes you feel we should be aware of?
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Does your child have any allergies?
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If yes, please list allergies
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Does your child have a history of |
Physical handicaps Rheumatic fever Heart problems Seizures Asthma Diabetes Other (describe) |
Please describe any instructions that would be helpful in caring or for your child, or special medical information needed by the child’s care staff/provider. |
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Camp T-shirt |
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Registration Fee |
authorize a $250 non refundable deposit to be charged immediately and credited toward tuition (will be refunded if the application is not accepted).
I understand that all applicants will be contacted to schedule a meeting with Rabbi Elishevitz to discuss: expected behavior, sign a behavior contract and bring along a check in the amount of $250 as a refundable security deposit. (the check will be returned on the last day of camp).
Camp Dates, Rates, & Deadlines:
16-day road trip for Jewish boys, in 10 - 12th, grades
Dates: Tuesday, July 19 - Wednesday, Aug. 2nd
Odyssey camp fee $2,200
Registration closes May 15th
After May 15th, Late registration camp fee $3,000 and will be put on a wait list
Click here for more details before you register.
Bank fee of 3% for credit card cancellations.
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*Payment Options
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Comments
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