Camper Information

*Last Name

*First Name

*Hebrew Name

*Gender

*Date of Birth

*Address

*City

*Province

*Postal Code

*Home Phone

*School

*Grade

Place my Child with

Medical Information

*Physician Name

*Physician Phone

*Ohip Number

*Allergies

Medical Note

Parent Information
Father

*Title

*First Name

*Last Name

*Work Phone

*Cell Phone

*Email

Mother

*Title

*First Name

*Last Name

Work Phone

*Cell Phone

*Email

*Marital Status

*Affiliation

Emergency Information

Name Phone # Relation

*Emergency 1

Emergency 2

Enrollment Options / Tuition & Fees

Please choose enrollment options

Sessions
Both Sessions


*Tuition

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

secure