Machane Lev Camper Application

Please fill out all sections completely

First Name *
First Name
Date of Birth *
Date of Birth
Home Address *
Home Address
Does the camper identify as Jewish? *
Parent/Guardian 1 Information
Name 1 *
Name 1
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Parent/Guardian 2 Information (Optional)
Name
Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Parent/Guardian 3 Information (Optional)
Name
Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Parent/Guardian 4 Information (Optional)
Name
Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Are campers parents/guardians seperated or divorced? *
Please select the cabin you would like to live in this summer. *
Machane Lev Camper Deposit
200.00
Quantity:
Submit