Register for Camp Revach!

If you have multiple children, please fill out this form, once for each child

Camper Name (First and Last):
Grade in Sept. 2021:
School:
Summer Length: 8th Grade is only 1st Half.
Street Address:
City:
State:
ZIP Code:
Phone Number:


Mother's Name:
Mother's Phone Number:
Mother's Email:
Father's Name:
Father's Phone Number:
Father's Email:


Bunk Request: While we try to accommodate all requests, we cannot guarantee any specific requests. Please enter up to 2 names and we will do our best to accommodate.
Doctor's Name:
Doctor's Phone Number:
Please list all Medications and/or Allergies:


Emergency Contact #1 Name:
Emergency Contact #1 Number:
Emergency Contact #1 Relationship:
Emergency Contact #2 Name:
Emergency Contact #2 Number:
Emergency Contact #2 Relationship:


How did you hear of us?
What would make your daughters summer incredible?
Transportation ($150/Half, $300/Full) (Optional):
Pizza Lunch (Optional):
Hot Lunch ($90/1st Half, $90/Second Half, $180/Full Summer) (Optional):

Payment Method: