BJE Teen Service Corps 2015

Choice of Session

Please indicate session:

Session 1: Monday, June 15 - Friday June 19 (Sinai Temple) This session is now FULL. If you would like to add your child to a wait list, please complete the registration form but indicate "pay by check" so that you do not have to submit payment with the form Session 2: Monday July 27 - Friday July 31 (Valley Beth Shalom) This session is now FULL. If you would like to add your child to a wait list, please complete the registration form but indicate "pay by check" so that you do not have to submit payment with the form.

Parent/Guardian I Information

Please note that our office will use Parent/Guardian 1 as the first contact for all emails, forms, and communications. Please let us know if you want us to send communications to both Parents/Guardians.

Last Name:

First Name:

Street Address:

City:

Zip Code:

Home Phone:

Cell Phone:

Business/Office Phone:

Email Address:

Parent/Guardian II Information

Last Name:

First Name:

Street Address (if different than Parent/Guardian I):

City (if different than Parent/Guardian I):

Zip Code (if different than Parent/Guardian I):

Home Phone(if different than Parent/Guardian I):

Cell Phone:

Business/Office Phone:

Email address:

Emergency Contact Information

First Name:

Last Name:

Relationship to Camper:

Home Phone:

Cell Phone:

Business/Office Phone:

Email address:

Registration is $315 per camper enrolled prior to April 30, 2015, and $340 after, with a $25 sibling discount.

To apply for a scholarship, please contact Camp Director Alisha Pedowitz at apedowitz@bjela.or following completion of this registration form.

Payment can be made via check or credit card through PayPal.

How would you like to pay for BJE Teen Service Corps 2015?

Credit Card via PayPalCheck (you will receive an invoice with your balance)I would like to find out scholarship information (please email Alisha for more information)

For payment by credit card, please indicate your payment amount:

$340$655 (includes sibling Discount for Two Campers)