The month long retreat is our classic camp experience, loved by hundreds of campers over the past 15 years. Campers enjoy a thrilling summer experience filled with art, creativity, nature, Jewish inspiration, and fun.

Registration Form

"*" indicates required fields

Camper Info

Camper's Name*

First Last

Camper's Hebrew Name*

Photo of Camper

Max. file size: 50 MB.

Camper's Cell Phone (for keeping in touch with other campers)

Camper's Email (for keeping in touch with other campers)

Camper's Date of Birth*

Month

Day

Year

Camper's School*

Grade entering*

56789

Tshirt Size*

Youth SmallYouth MediumYouth LargeAdult Extra SmallAdult SmallAdult MediumAdult LargeAdult Extra Large

Traveling From

Contact Info

Home Phone*

Parent 1 Name*

First Last

Parent 1 Phone*

Parent 1 Email*

Parent 2 Name

First Last

Parent 2 Cell Phone

Parent 2 Email

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

References

How did you hear about the retreat?

What camp did you attend last year?

Reference Name*

Reference Phone Number*

Camp Experience

Please describe the camper and tell us anything that might be helpful to know about her.

How would you like to see your daughter grow through the retreat?

Camper's Hobbies

Allergies, dietary restrictions, medical issues, etc.

Comments or Suggestions

Consent*

I understand that my daughter may be photographed at the retreat and used in JGU promotional materials.

Payment

Payment Method*

Charge my card the full price: $3450 (if you have a coupon code you can enter it below)

Charge my card 4 installments of $862.50

I will mail a check to 12 Thompson Hill Rd, Rensselaer, NY 12144

Registration Fee: $180*

Price:

Full Price

Price:

Installments

Price:

Coupon

Total

Comments

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