New Camper Application

Trip 1 - July 6th - July 26th

Trip 2 - July 28th - August 16th

Cost:

CLOSED OUT! - Trip One - $2200 + $100 Tips - CLOSED OUT!

($1200 non-refundable deposit required upon acceptance)

Trip Two - $2200 + $100 Tips

($1200 non-refundable deposit required upon acceptance)

Phone: 203-456-CAMP(2267).

Camper's Name *

First Name Last Name

Birth Date *

Month Day Year

Please upload a photo (head shot) of the applicant *

What Grade is your daughter currently in? *

What School does she attend? *

Please list a school reference for your daughter *

Full Name

Phone Number of the above reference (preferable not the general school number) *

Please enter a valid phone number.

Email address for the above reference if available *

please write na@na.com if not available

What trip would you like her to attend? *

Would you like to share anything else about your camper('s)? Do you know someone who went to Camp Ahuvah last year?

Do you have an additional camper who would like to apply? *

New Camper's Name #1 *

First Name Last Name

Birth Date *

Month Day Year

Please upload a photo (head shot) of the addition new camper applicant

What school does your additional new camper attend? *

What trip would your additional new camper like to attend? *

What Grade is additional camper #1 currently in? *

Please list a school reference for your additional camper #1 *

Full Name

Phone Number of the above reference (preferable not the general school number) *

Please enter a valid phone number.

Email address for the above reference if available *

please write na@na if not available

New Camper's Name #2 *

First Name Last Name

Birth Date *

Month Day Year

Please upload a photo (head shot) of the new camper #2 *

What school does your additional new camper #2 attend? *

What trip would your additional new camper #2 like to attend? *

What Grade is additional camper #2 currently in? *

Please list a school reference for your additional camper #2 *

Full Name

Phone Number of the above reference (preferable not the general school number) *

Please enter a valid phone number.

Email address for the above reference if available *

please write na@na if not available

Marital Status *

Father's title (Rabbi, Dr., Mr.)and first and last name *

First Name Last Name

Mother's first and last name *

First Name Last Name

Mother's maiden name *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Number *

Primary Cell Number *

Secondary Cell Number

Primary E-mail *

example@example.com

Secondary E-mail

example@example.com

I understand that my daughter's acceptance is dependent on availability and by submitting this application she is not automatically accepted. Upon acceptance, I understand that a non refundable deposit will be required to secure her spot.

**If state regulations do not allow overnight camps to operate for summer 2021, please be advised that 75% of your monies will be returned.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Ahuvah during the selected camp. In exchange for the acceptance of said child’s candidacy by Camp Ahuvah, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Camp Ahuvah and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Camp Ahuvah including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball and the like.

Signature *

Clear

New Camper Application

Parent Information