To register, please fill out carefully. Tuition is $300 1 Week, $600 2 Week program.
CGI subsidies available call 517-214-0525.
When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
   First
Middle
Last  
Address
 Street
City State
Zip
Date of Birth
Contact Info
 Phone
Email
Schools
 School
Hebrew School Entering Grade:
Child's Mother
 Mother's Name
Hebrew Name Work Phone Cell
Child's Father
 Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
 Name
Phone
Relationship
Pediatrician
 Name
Phone

Email
Select
Week 1
9:30am - 3:30pm
 $300.00
Week 2
7:45am- 4:55pm
 $300.00
IMPORTANT
•
 All forms must be completed and submitted before your child begins camp.
With the submission of this form I am paying for: 1 Week 2 Week's 1 Day 2 Days
•
 I will be paying by: Check Mastercard Visa Amex

Card Number

 Expiration Date (mm/yy)
Cardholder
Name
 Total Amount
I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
Date of Application: