Camp ECC Mommy and Me 2019

* Child's Last Name

* Child's First Name

* Date of Birth

* Home Phone Number

* Preferred Email Address

Additional Preferred Email Address

* Address

* City

* State

* Zip Code

* Mother's First Name

* Mother's Last Name

* Mother's Cell Phone

Mother's E-mail Address

Father's First Name

Father's Last Name

Father's Cell Phone

Father's E-mail Address

Nanny's Name

Nanny's Cell Phone

Are you a congregant of Congregation Agudath Israel?

Please Select OneYesNo

* Would you like information regarding membership?

Please Select OneYesNo

* Are you members of any other congregation?

Please select oneYesNo

If so, which one?

How did you hear about us?

Comments

Total

Payment in full is required for Mom and Me at the time of registration. Tuition includes a $50 non-refundable registration fee. Camp expenses are incurred whether or not a camper attends; therefore, refunds of any kind will not be made for absences or withdrawals from the camp program after June 1.

June 16,2019 /
13 Sivan 5779

June 16,2019 / 13 Sivan 5779

Camp ECC Mommy and Me 2019

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