Clone of Camp On-The-Go 2025 Application Form

Camper Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Format: (000) 000-0000.

Father's Cell Phone Number

Format: (000) 000-0000.

Mother's Cell Phone Number

Format: (000) 000-0000.

Email for confirmation and information

Optional Secondary Email

Birth Date

Age During Camp

Current Grade

Current School

Current Rebbe

Rebbe Phone

Emergency Contact (Not a Parent)

First NameLast Name

Emergency Contact Relationship

Emergency Contact Phone Number

Format: (000) 000-0000.

Pediatrician Name

Pediatrician Number

Please enter a valid phone number.Format: (000) 000-0000.

List Any Allergies

Provide any information on medical conditions, psychological conditions, behavioral conditions, medications, dietary restrictions, or special needs that we need to be aware of to ensure that your son's camp experience is positive.

Please Read and Check Box

I understand that there will be no refunds or reductions for days missed or for early departure from camp. I hereby authorize Camp to administer First Aid or to take my son to a doctor or hospital for any treatment which Camp deems necessary if a parent can not be reached. I accept responsibility for any medical charges which may be incurred on my son's behalf. I give my child permission to take part in all Camp activities and trips. I agree to be financially responsible for any damages or expenses caused by my son. I give Camp permission to use any photographs or media in which my son appears. It is understood and agreed that if the camper's conduct or influence is not up to the camp's standards, the camper will be dismissed at the discretion of Camp with no refund or reduction in fee. By checking this box, I hereby indicate that I have read, understood, and agree to all of these terms.

Please indicate what size t-shirt your son wears

Camp Session/s Camper is Registering for:

If registering for the weekly option only, indicate which week/s:

Deposit Payment - $200 for a whole session/$50 per week - Application not accepted until full deposit has been received

Credit Card Payment - Please check the appropriate boxes

First Session Deposit: June 24 - July 17

$200

Second Session Deposit: July 20 - August 14

$200

Post-Camp Week Deposit August 17 - August 21

$50

Weekly Option Deposit

Do NOT check this box if registering for a FULL SESSION or for the extra Week

$50 How many weeks
Item subtotal:

Extra Camp T-Shirt

$15 How many extra shirts

Donate and help another child have a great summer too

Any amount is greatly appreciated and will go directly towards a scholarship for a child.

Free Donation Amount

Total

Credit Card

* Deposit is applied towards camp fee

* Full camp fee will be due by June 1

* Camp fee includes supplies, trips and everything else

Any additional questions or comments, please let us know

Camp On-The-Go Registration Form 2026

Credit Card Payment - Please check the appropriate boxes

Credit Card