Camp Application

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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*
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: $175.00
Coupon
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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Camp Application

Personal Information

Family Information

Affiliation

Recommendations

Payment

Digital Signature