Camper Registration Form – Camp Chesed | Camp Dora Hauser

Camper Registration Form

Camper Registration Form

Name

Phone Number

Email

Street Address

Address Line 2

City

State

Zip/Postal Code

Country / Region

Upload a recent Picture

Maximum file size: 516MB

Gender

School

Age

Weight

Height

T-Shirt Size

Alergies

Medication

Type of Disability

Physician's Name

Physician's Phone Number

Parent's Name #1

Parent's Phone #1

Parent's Name #2

Parent's Phone #2

Emergency Contact 1

Emergency Contact Number 1

Emergency Contact 2

Emergency Contact Number 2

Parents Address if different than above

Address Line 2

City

State

Zip/Postal Code

Country / Region

What would you like to do at Camp Chesed?

Hobbies

Number of siblings and ages still living at home

Pets' Names

Synagogue Affiliation and Rabbi's Name

Captcha

If you are human, leave this field blank.