Program Registration
* First Name:
* Last Name:
* Birth Date: (mm/dd/yyyy)
* Address 1:
Address 2:
* City:
* State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* Zip:
* Home Phone: (123-456-7890)
Teen's Cell Phone: (123-456-7890)
* Primary Home Email:
Teen's Email:
* Grade:(Fall 2012)
7
8
9
10
* School:(Fall 2012)
Parent 1:
* Name:
* Cell Phone: (123-456-7890)
Business/Occupation:
Business Phone: (123-456-7890)
Email:
Parent 2:
* Name:
Cell Phone: (123-456-7890)
Business/Occupation:
Business Phone: (123-456-7890)
Email:
Camper lives with:
Both Parents Mother Father Other
* Camper will participate in:
Session 1: August 6-10 Session 2: August 13-17
* Are you member of a synagogue?
Yes No
* Please select which pick-up/drop-off location you would prefer during the camp week: (Please note, the suburban locations are not guaranteed and exact locations will be provided in the weeks leading up to camp).
Northbrook area Skokie area Downtown (30 S. Wells Street)
* Do you authorize you and your teen's name and contact information to be listed on the Camp TOV roster to be mailed to Camp TOV participants prior to Camp?
Yes No
* Emergency contact information If parent/guardian is not available in the event of an emergency, please notify:
* Name:
* Relationship:
* Cell Phone: (123-456-7890)
* Home Phone: (123-456-7890)
Dietary information
* Is your child a vegetarian?
Yes No
* Does your child have any allergies (food, medicine or other)?
Yes No
*
Each participant will be provided with two t-shirts, which are to be worn each day of camp. Please check your teen’s t-shirt size (adult sizes):
Small Medium Large Extra-Large
Teens may bring a brown-bag, kosher-style lunch to camp OR sign-up for a meal plan. Camp TOV will include one lunch on the Monday of camp regardless of the meal plan. Kosher snacks will be provided.
Check this box to include 4 kosher (CRC certified) lunches: add $25
You must register for the lunch program no later than July 2, 2012
Payment:
Get the worm - February 1 - March 2: $250*
Early bird March 3 - April 30: $270*
Registration may 1 - June 29: $290*
*In keeping with the spirit of Camp TOV, $18 of the program cost supports JUF's Annual Campaign, helping 300,000 Chicagoans get the food, housing, medical care, job training and other social services they desperately need. Additional donations also are welcome.
Additional donation:
Refer a friend
Name:
Email:
Name:
Email:
* (indicates required field)