Camp B’Lev Echad Application

Opening
Child information
Parent information
Emergency & Medical
Terms & Cost
Payment

Click Here To Download Camp Video

Child information

Parent information

Father's Title

Father's Name

Father's Day Time Phone Number

Mother's Title

Mother's Name

Mother's Day Time Phone Number

Marital Status

Email Address

Home Phone

Address

Street

City

State

Zip

Emergency Contacts

First Name

Last Name

Relation

Phone

First Name

Last Name

Relation

Phone

Medical Information

Family Doctor

Family Doctor Phone

Does Your Child Have Any Allergies?

Is Your Child Taking Any Daily Medication?

My Child Is Allergic To

My Child Takes Daily

To help us best service your son, please specify if and what services they are receiving.

I give camp blev echad permission to give medication to my son

Camp Information

Camp dates

July 23rd through August 19th

Camp hours

Monday - Thursday 9:30 - 4:30

Friday 9:30 - 12:30

Camp Fees:

Currently In:

Primary, 1st grade: $895

2nd, 3rd grade $995

4th - 7th grade: $1,095

Transportation (optional): In Lakewood - $175, Out Of 08701 Area Code - $225

Lunch: included in camp fee

Conditions

Camp conditions:

In the event of a medical emergency, I hereby give authority to Camp BLev Echad staff to obtain necessary medical treatment for my child(ren):
I am aware that my son(s) will be swimming in a supervised pool and will be traveling on trips and excursions as part of the camping program. I agree not to take any legal action against Camp BLev Echad or its staff.
I will be held liable for any and all damages incurred by my child.
I consent that any photo or video of my child taken by Camp BLev Echad may be used for marketing purposes.
I am hereby mafkir all of the belongings that my child leaves in Camp BLev Echad after the summer is over (August 19th, 2025).

I would like to register child(ren) in Camp BLev Echad.

I would like transportation for child(ren).

Parent/Guardian Name (Print):

Parents Signature

Date

Payment

A $300 non-refundable deposit per child is due at time of registration, and will be deducted from your total camp bill. Full payment must be received within 4 days of applying. Head checks dated no later than July 1st are acceptable.

Total camp fee and transportation fee is non- refundable after July 1st.

Please Select Payment Option:

Credit Card - Full Payment

Credit Card - Deposit Only. Charge remaining on July 1st

Credit Card - Deposit Only. Pay remaining monthly.

Check

Zelle

2% added to charge amount to defray our cost

Remaining balance $ will be charged on July 1st

Remaining balance will be charged monthly for $. Scheduled dates:

Billing Address

Address

City

State

Zipcode

Card Details

Name On Card

Card Number

Expiry Date

CVV

Early Bird price: $ $

Amount

Text

Camp B’Lev Echad Application

Click Here For General Camp Information

Billing Address

Card Details