Ashreinu

Fill out the form below or download the application form

Overnight application 2020

Day camp application 2020

General Information

Child's Last Name

First Name

Hebrew Name

Date of Birth

Place of Birth

Age

School

Grade Completed

Address

City

Prov

Zip

Home Phone

Camper Cell

Camper Email

Emergency Contact

Emergency Contact Phone

Medical Information

Health Card Number

Is there any special information which is important to know?

Medical:

Other:

References

(Principal, Teacher)

Reference 1

School Phone

Home Phone

Reference 2

School Phone

Home Phone

Family Information

(If single parent, please include applicable information and addresses)

Father

Marital Status

Occupation

Home Phone

Cell Phone

Business Phone

Mother

Marital Status

Occupation

Home Phone

Cell Phone

Business Phone

Jewish Affiliation

Synagogue

Rabbi

Session