Camp Ramah Sasson Pediatric Oncology Family Shabbaton 2025

Application Camp Ramah Sasson Pediatric Oncology Family Sabbaton 2025

Our 2025 Camp Ramah Sasson Family Shabbaton will run from April 25-27. Be sure to download the Oncology Physical Exam form at the end of this registration and have your child's doctor fill it out. Following receipt of the doctor form, applications will be reviewed by our medical committee and you will be contacted with confirmation of registration. Please email Riki Wiederhorn, Director of Year Round Programs, at rikiw@campramahne.org with any questions.
Family Name*
This is the name that will be used to refer to your family unit throughout the program.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Secondary Email
example@example.com
Phone Number*
Please enter a valid phone number.
Synagogue Affiliation
What synagogue do you belong to?
How did you hear about Camp Ramah Sasson?*
Information About the Child with Cancer

The more information we have, the better understanding we will have of your child's needs and how we can best accommodate him/her.
Name*

First NameLast Name
Child's Diagnosis*
Date of Diagnosis*

MonthDayYear
Date
Date of Completion of treatment (if applicable)

MonthDayYear
Date
Treatment Center*

NameCity/State
Oncologist*

NamePhone Number
Social Worker (if applicable)

NamePhone Number
Nutritional Needs. Please share any dietary restrictions and/or food allergies/sensitivities.*
Please share any physical limitations. (ie. wheelchair, crutches, amputation, impaired sight or hearing)*
Birthday*

MonthDayYear
Date
Grade in Spring 2025*
T-Shirt Size*
Additional Participants
Who will be attending with the child with cancer?
Do we have permission to share your contact information with other Camp Ramah Sasson families?*
Medical Information or Special Needs
Will you be bringing an EpiPen to Camp Ramah Sasson?
Who is the EpiPen for?
Please indicate any additional medical needs or non-food allergies of any participants that we should be aware of in order to best accommodate your family.
Is there anything else we should know to help make your stay with us comfortable?
Ramah Connection
Will anyone in your family be a Ramah camper in summer 2025?*
Please list their name(s) and which camp they will be attending?
Is anyone in your Family a Ramah alum?
Which camp and which years? (Please include years spent both as a camper and staff member)
Would someone in your family be interested in leading T'fillah (services) or reading Torah during the weekend?
Please select:

Reading TorahReading HaftorahLeading weekday ShacharitLeading Kabbalat ShabbatLeading Shabbat Ma'arivLeading Shabbat morning ShacharitLeading Shabbat morning Musaf
Camp Ramah Sasson Policy and Procedures
Photo Release:
Throughout this weekend, we will document the experience with photos and videos that we will share with you! Please sign below to authorize Camp Ramah in New England to use photos and video images of my family for publicity purposes.

COVID-19 Protocol:
Ramah New England strongly encourages all eligible participants and staff to be fully vaccinated against Covid 19 prior to the program.

Additional requirements related to COVID may be necessary based on current conditions. Information will be communicated as it becomes available.
Signature*

Clear
Physical Examination Form

Download, print and bring to your child's Oncology team to be completed.
Please download and print out this MEDICAL FORM to be filled out by your child's Oncology team. Your application will only be concidered complete once we receive this form. It will then be reviewed by our Medical committee to complete registration.

ONCOLOGY PHYSICAL EXAMINATION FORM
Should be Empty:

Application Camp Ramah Sasson Pediatric Oncology Family Sabbaton 2025

Information About the Child with Cancer

Additional Participants

Medical Information or Special Needs

Ramah Connection

Camp Ramah Sasson Policy and Procedures

Physical Examination Form