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Camp Koby 2015
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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
*
Level
Excellent
Very Good
Good
Fair
Poor
Birth Date
*
MM
DD
YYYY
Camps in Previous Summers
Summer 2018
*
Summer 2017
*
Summer 2016
*
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 2019
Entering 12th grade in Sept 2019
Synagogue
*
Name of Rabbi
*
Recommendations
At least one must be from a current Judaic Studies Teacher. No Family members or family friends.
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.
Payment
Camp Application
Price:
$25.00
Total
$0.00
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
Parents Signature
*
Campers Signature
*
Date
*
Photo Upload
*
Accepted file types: jpg, gif, png.
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