Do more at KesherTech, all in a Torah environment!

• Horseback riding  • Climbing  • Sports  • Swimming  • Boating  • Serious ruach
• Robotics  • Acting  • Hiking  • Camping  • Two big trips  • And much more

Camper Information

Grade (Next Year): Date of Birth:

Called up to Torah as (if 13):

Returning Camper:

Specialty Track:

Specialty-Track Background: (Please briefly describe your background and experience in the skills relating to the specialty-track you selected.)

My son is applying to be an  camper.

Father's Contact Information

Father Name: Father Day:

Father Cell: Father E-mail:

Mother's Contact Information

Mother Name: Mother Day:

Mother Cell: Mother E-mail:

Summer Phone (if different): Marriage Status:

Emergency Contact Information

Contact 1:

Phone: Relationship:

Contact 2:

Phone: Relationship:

Contact 3:

Phone: Relationship:

Education

School Currently Attending:

Previous School: Years:

References

Rebbi Name:

Rebbi Home: Rebbi Work:

Menahel Name:

Menahel Home: Menahel Work:

Health

Health Restrictions:

Medication:

Allergies:

Dietary Restrictions:

Camp T-shirt Orders

T-shirt Size: T-shirt Quantity:

****    ****    ****    ****    ****

Transportation and Bunk Request sections
are for overnight campers only.

Bunk Requests

Please list three people with whom your son would like to share a bunk. (We can not guarantee bunk-mates, but we will do our best.)

1)

2)

3)

Transportation

To Camp: From Camp:

Flight Information (if relevant):

****    ****    ****    ****    ****

I understand that acceptance to camp will be decided by Kesher Tech. Kesher Tech may use any photos, slides and / or video that include my son. The deposit, which is $500 for overnight campers and $300 for day campers, and all fees are fully-refundable if camper is not accepted to camp. The deposit is otherwise non-refundable. All fees are due in full by May 1, 2012 and are non-refundable thereafter. There are no refunds or partial refunds for early departure or dismissal from camp.