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Online Registration

Online Registration

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
7:45am- 4:55pm
$300.00
Week 2
9:30am - 3:30pm
$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:


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