Camp Shamayim Registration Form 2017 If you are a human and are seeing this field, please leave it blank. $150 per session $10 sibling discount Payments are requested every Friday Please make checks payable to Camp Shamayim I would like to enroll my Daughter(s), Son(s): (If applying for more than one child, you may use the same form and write the information in the same order for each field .) Please check off which sessions you will be attending. Sessions Week 1 June 19 - June 23Week 2 June 26 - June 30Week 3 July 3 - July 7Week 4 July 10 - July 14Week 5 July 17 - July 21 Contact Information First Name Last Name Address 1 Address 2 City State Georgia Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Email Home Phone Cell Phone Medical Information My Child's Doctor Doctor's Number Please include any allergies or medical information about your child(ren) I DO NOT HOLD CAMP SHAMAYIM LIABLE FOR ANYTHING ARISING CHAS V'SHALOM DURING THE DURATION OF CAMP 2017 If you have any talents or hobbies please let us know! We always enjoy special visitors.