Explore Jewish tradition & culture through the arts!

Monday - Friday, July 18 - 22, 9:00 am - 2:00 pm; drop off option at 8:30 am. A week of Jewish theater, arts & crafts, music, culture, food and movement.

Cost: $80 for one camper, $72 for each additional camper. Camperships available by request

Adult 1 First Name

Adult 1 Last Name

Adult 1 Phone Number

Adult 1 Email

Adult 2 First Name

Adult 2 Last Name

Adult 2 Phone Number

Adult 2 Email

How many children are you registering for Camp Shalom?

Camper 1

First Name

Last Name

Date of Birth

Incoming Grade

Age

Medical & Allergy Information

Does Camper 1 take any medication?

YesNo

If yes, please list medications & if they will need to be administered during camp, with dosage information

Does Camper 1 have any allergies or food restrictions?

YesNo

If yes, please describe allergy & food restrictions

Camper 2

First Name

Last Name

Date of Birth

Incoming Grade

Age

Medical & Allergy Information

Does Camper 2 take any medications?

YesNo

If yes, please list medications & if they will need to be administered during camp, with dosage information

Does Camper 2 have any allergies or food restrictions?

YesNo

If yes, please describe allergy & food restrictions

Camper 3

First Name

Last Name

Date of Birth

Incoming Grade

Age

Medical & Allergy Information

Does Camper 3 take any medication?

YesNo

If yes, please list medications & if they will need to be administered during camp, with dosage information

Does Camper 3 have any allergies or food restrictions?

YesNo

If yes, please describe allergy & food restrictions

Camper 4

First Name

Last Name

Date of Birth

Incoming Grade

Age

Medical & Allergy Information

Does Camper 4 take any medication?

YesNo

If yes, please list medications & if they will need to be administered during camp, with dosage information

Does Camper 4 have any allergies or food restrictions?

YesNo

If yes, please describe allergy & food restrictions

Emergency Contact

The following people have permission to pick up my camper from camp on a regular basis or in case of an emergency when one or both parent/guardians are unreachable.

Emergency Contact 1 Full Name

Emergency Contact 1 Relationship to Camper(s)

Emergency Contact 1 Phone Number

Emergency Contact 2 Full Name

Emergency Contact 2 Relationship to Camper(s)

Emergency Contact 2 Phone Number

The Fine Print

I approve of the above registration for my camper(s). I give permission for my camper(s) to take part in all activities, including water activities.

I understand that the Director of Camp Shalom will contact me (or another emergency contact if I cannot be reached) in case of emergency. I hereby grant permission for my camper to be treated by camp staff for basic first aid.

Adult Signature

This will serve as an electronic signature

Date

Total Camp Fees

Camp Shalom Registration 5782

Camp Shalom Registration 5782

Explore Jewish tradition & culture through the arts!

Camper 1

Medical & Allergy Information

Camper 2

Medical & Allergy Information

Camper 3

Medical & Allergy Information

Camper 4

Medical & Allergy Information

Emergency Contact

The Fine Print