Camp Application

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Step 1 of 2

Personal Information
Name*
First Middle Last
First name (Commonly Used)*
US Passport Number*
US Passport Expiration Date*
Israeli Passport Number (if you have)
Israeli Passport expiration date (If you have)
Email*
Address*
City*
State*
Zip*
Gender*
- Male
- Female
Phone*
Cell Phone*
Level of Spoken Hebrew*
Birth Date*
Camps in Previous Summers
Summer 2016*
Summer 2015*
Summer 2014*
Family Information
Father's Name*
First Last
Father's Email*
Father's Phone*
Father's Cell*
Father's Occupation*
Mother's Name*
First Last
Mother's Email*
Mother's Phone*
Mother's Cell*
Mother's Occupation*
Affiliation
School*
Grade*
- Entering 11th grade in Sept 2017
- Entering 12th grade in Sept 2017
Synagogue*
Name of Rabbi*
Recommendations
at least one must be from a current Judaic Studies Teacher
First Contact
Title - First Contact*
Name of First Contact*
First Last
Phone - First Contact*
Email - First Contact*
Relationship - First Contact*
Second Contact
Title - Second Contact*
Name of Second Contact*
First Last
Phone - Second Contact*
Email - Second Contact*
Relationship - Second Contact*
Tell us why you want to come to the Camp Koby Summer in Israel Experience*

Please tell us why you want to come on our program and specifically why you are interested in volunteering with bereaved children.
Digital Signature
Retype your name and date to sign digitally
By signing this application, I certify that my child is eligible to attend the The Koby Mandell Foundation Summer in Israel Experience without reservations, and I agree to pay the fee listed. I agree to pay for any property damages that might be caused by my child. Application fee is $200 US (£150 for UK residents) ($150 if applying by December 30th).
Parents Signature*
Campers Signature*
Date*
Photo Upload*
Accepted file types: jpg, gif.

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Card Holder Information
Name of Card Holder*
Card Holder Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Card Holder Phone Number*
Credit Card Information
Credit Card Type*
Card Number*
Security Code*
Exp. Month*
Exp. Year*

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Camp Application

Step 1 of 2

Personal Information

Family Information

Affiliation

Recommendations

Digital Signature

Card Holder Information

Credit Card Information

Camp Application

Sign Up Today For the Camp Koby Experience

Staff Application

Koby Mandell Foundation Summer in Israel Programs

School Visits

Learn About Camp Koby in Your Local School

Application Process

Get more info on how to apply and about our early bird specials