• Girls Division Pesach Application 2023

    Sunday, April 9th- Friday, April 14th

  • The Girls Division Pesach Program will be taking place this year in Bricelyn, Minnesota. The program begins on Sunday, April 9th - Friday, April 14th.

    Travel arrangements will be made by Project Extreme. Tuition for the Pesach Program is $750* and includes all Project Extreme transportation and activity fees. Complete the Payment and Scholarship form to request scholarship consideration.  *A $50 deposit is required at the time of registration.
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  • Emergency Contact Information

    Emergency Contacts must reside in within the US and be available 24 hours/day

  • Medical Information

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  • Applicant Insurance Information

    Please check with your insurance carrier about your particular coverage while your child is at Camp Extreme. Project Extreme will not be responsible for medical loss or costs for any camper. An additional travel medical policy is recommended. Contact www.travelguard.com for several third party plan options.
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  • Please fill in the following information:
    Primary Insurance Name   
    Name of Policy Holder       DOBPick a Date   
    Relationship to Patient   
    Patient's Policy ID No.   Policy Start DatePick a Date   
    Secondary Insurance Information
    Secondary Insurance Name (if applicable)    
    Name of Policy Holder      DOB   Pick a Date   
    Relationship to Patient   
    Patient's Policy ID No.   Policy Start Date   Pick a Date 

  • Urgent Care and Miscellaneous Fees
    The card below will only be used for reimbursements in the following circumstances:

    - Should my child need to be seen by a physician while on the Camp Extreme program, I understand that I am responsible for all costs and fees.


    - I acknowledge that all baggage related fees on the flight home from Camp Extreme are at my expense.

    Signature of Parent or Guardian*   Pick a Date   
    Visa or MasterCard Number*   
    Exp. Date   * CVV *   
    Billing Address   *      *   *   *   

  • MEDICAL AUTHORIZATION FORM

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  • APPLICANT AGREEMENT

    Please review carefully and sign at the bottom. If you have any questions, please contact us as soon as possible. This agreement must be part of the applicant’s file in order for it to be complete.

  • Legal Name of Applicant   *  *    

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  • Payment and Scholarship Information

    Tuition for the Pesach Program is $750 and includes all Project Extreme transportation and activity fees. $50 non-refundable deposit required.
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        Girls Division Pesach 2023
        $750.00
          
        Deposit*
        $50.00
          
        Total
        $0.00

      • Transportation Information

        Travel arrangements will be made by Project Extreme. Participants will depart on Sunday, April 9 to MSP and return on Friday, April 22.

      • - It is the participant's responsibility to arrive at the airport on time and make their flight. Additional flight costs due to late airport arrival will be at the expense of the participant.
        - Please confirm baggage requirements with your airline and any possible related costs. As you will see from the packing list, a sleeping bag and pillow will be needed.
        -A valid driver's license or passport is required to fly domestically. It is the participant's responsibility to ensure that they have proper identification.       

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