Name: JGR Winter Retreat
Start: 2025-12-25T13:00:00+00:00
End: 2025-12-28T17:30:00+00:00
Location: Jewish Greenbush Retreat

Join us at the 19th Annual Jewish Girls Winter Retreat!

Enjoy…

…and much more!

Registration Form

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*
Tshirt Size*
Traveling From
Contact Info
Home Phone*
Parent/Guardian 1 Name*
First Last
Parent/Guardian 1 Phone*
Parent/Guardian 1 Email*
Parent/Guardian 2 Name
First Last
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Email
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
References
How did you hear about the retreat?
What camp did you attend last year?
Reference Name*
Reference Phone Number*
Medical Info
Medical Insurance Policy #*
Front of Insurance Card
Max. file size: 50 MB.
Back of Insurance Card
Max. file size: 50 MB.
Policyholder Name*
First Last
Policyholder Date of Birth*
Month
Day
Year
Emergency Contact Name*
Emergency Contact Phone Number*
Allergies, dietary restrictions, medical issues, etc.
Does your daughter take any daily medications? If so, list them here:
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
Comments or Suggestions
Consent*
I understand that my daughter may be photographed at the retreat and used in JGU promotional materials.
Payment
Winter Retreat*
Price:
Coupon
Total
$0.00

JGR Winter Retreat