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OORAH'S GIRL ZONE APPLICATION - 2010 Season

Camp Dates for Summer 2010:
1st session: June 30, 2010 through July 26, 2010.
2nd session: July 28,2010 through August 23, 2010.

Please fill out one application for each child. We will NOT process your application unless it is completed in full. If something is not applicable to you, please write "None".

Camper's Information Camper's Last Name:
Camper's First Name:
Camper's Address:
Apt #:
City:
State:
Zip:
Country:
Camper's Home Phone:
Emergency Contact Name:
Emergency Contact Number:

Father's Information Father's Last Name:
Father's First Name:
Father's Occupation:
Father's Business Phone:
Father's Cell Phone:
Father's Email:

Mother's Information
Mother's Last Name:
Mother's First Name:
Mother's Occupation:
Mother's Business Phone:
Mother's Cell Phone:
Mother's Email:

Family Information Parents' Marital Status: Married Separated

Divorced Widowed

If separated, widowed or divorced, who does the child stay with?

If divorced, who has legal custody of the child?

How many siblings does Camper have?

Siblings' Ages:
Schools Siblings attend:

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Additional Camper Information Camper's Preferred Name:
Camper's Date of Birth: (mm/dd/yyyy) Invalid format.A value is required.

Camper's Social Security #:
Camper's Ethnicity:
Campers' Email Address:
Camper's Cell Phone:
Camper's current Grade: (as of 09-10)
Camper's Current School:
Attended Since: (year)
Camper's Hebrew Teacher:

Camper's Previous Schools:

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Camper'sPrevious Camps:

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Camper's friends attending Girlzone:

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Camper's Special skills or interests:

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Where did Camper go last summer?

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Why do you want to come to our camp?

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Are there any Special Instructions for this Camper?
(allergies, medications)

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How did you hear about GirlZone?
Other:

Camper References List two references, such as your school Principal, Rabbi, Teacher, Counselor or Community Rabbi.
Reference Name:
Daytime Phone
Evening Phone
Relationship to Camper:
Reference Name:
Daytime Phone
Evening Phone
Relationship to Camper

Camper's Family Affiliation Status of Applicant: Born jewish Converted Not Jewish

Status of Applicant's Father: Born Jewish Converted Not Jewish

Status ofApplicant's Mother: Born Jewish Converted Not Jewish

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Officiating Rabbi:
Synagogue affiliated with:
Rabbi's Name:
Rabbi's Phone:

Select a Girlzone Session:

Session 1 Only: June 30, 2010 through July 26, 2010

Session One Cost: $1499

Session 2 Only: July 28, 2010 through August 23, 2010

Session Two Cost: $1499

Whole Summer: June 30, 2010 to August 23, 2010

Whole Summer Cost: $2998

Discover U (Ages 18-25): Visit: www.youdiscover.org

A deposit of $200 is required at the time of registration, to be applied to total camp fees. The deposit will be refunded if the applicant is not accepted to Camp.

Applications received without a deposit for each applicant, will not be processed.
No refund for cancellations after May 1st.
Payment in full must be received by May 15th.

Additional Camp Information

For scholarship information, fill out the online financial aid application or please call us at 1.877.447.5966.

For additional assistance, contact your local federation or visit the Foundation for Jewish Camping at www.jewishcamp.org.

For further help filling out this form, please call us at 1-877-GIRLZONE. If your application does not go through after hitting the 'Continue' button, please scroll to the top of the application and make sure the fields were filled out correctly.

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