Camp Application | Camp Koby

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 2017*

Summer 2016*

Summer 2015*

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 2018
Entering 12th grade in Sept 2018

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: $200.00

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*