Teen Information
First Name (shown on ID)*
 Gender*
 Current Grade*
 

On a scale from 1 to 10, how adventurous are you?
5  6  7  8  9  10 
 
Parent Information
Address*
Marital Status*
Father's Name

 
Mother's Name

 
 
Health & Transportation
Emergency Contact Information
Physician or Medical Facility
Phone
     
 
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*
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*
 
Health History and Special Instructions
List any illnesses your child had within past 6 months
 List any Sensitivities your child has. Any dislikes you feel we should be aware of?
  
Does your child have any allergies?
 If yes, please list allergies
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.
 
Camp T-shirt
   
 
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.

*Payment Options
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