Camper Information

*Last Name

*First Name

*Hebrew Name


*Date of Birth




*Postal Code

*Home Phone



Place my Child with

Medical Information

*Physician Name

*Physician Phone

*Ohip Number


Medical Note

Parent Information


*First Name

*Last Name

*Work Phone

*Cell Phone




*First Name

*Last Name

Work Phone

*Cell Phone


*Marital Status


Emergency Information

Name Phone # Relation

*Emergency 1

Emergency 2

Enrollment Options / Tuition & Fees

Please choose enrollment options

Both Sessions


Bus Transportation

Total Amount:

A $400 nonrefundable deposit is included.

Payment Information

*Card Type

*Card Number

*Expiration Date

*Security Code

Use Information above

*Name on Card

*Billing Address

*Billing Postal Code

I agree to the terms and conditions above