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Camper Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Fathers Email(Required)

Mothers Email(Required)

Fathers Name(Required)

First

Fathers Cell Number(Required)

Mothers Name(Required)

First

Mothers Cell Number(Required)

School(Required)

Current Grade(Required)

T-Shirt Size(Required)

Rebbe's Name(Required)

Rebbe's Phone(Required)

Name(Required)

Cell Number(Required)

Name(Required)

Cell Number(Required)

Early Bird (Until Jan. 1st): $1,900

After Jan. 1st: $2,150

By submitting your Credit Card below, we will charge you $380 each month for the next 5 months.

Recurring(Required)

Credit Card

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