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Camp Gesher 2024
Camp Gesher 2024
Temple Anshe Hesed - Camp Gesher 2024
The dates for this year's Camp Gesher is August 12-16. Cost per student is $125.
Please sign into your Temple Account before completing the online registration. If you need assistance with this, please contact the Temple office at 814-454-2426.
Family Name
STUDENT INFORMATION
How many students are being registered?
Please Select One
One student
Two students
STUDENT 1 INFORMATION
Student 1
Camp Gesher - $125
Student 1 - Name
Student 1 - Date of Birth
Student 1 - Secular Grade
Student 1 - Secular School
Student 1 - Preferred Pronoun
(i.e. he, him, his, she, her, hers, they, them, theirs)
Student 1 - Allergies
Student 1 - Health Concerns
Student 1 - Special Needs
STUDENT 2 INFORMATION
Student 2
Camp Gesher $125
Student 2 - Name
Student 2 - Date of Birth
Student 2 - Secular Grade
Student 2 - Secular School
Student 2 - Preferred Pronoun
(i.e. he, him, his, she, her, hers, they, them, theirs)
Student 2 - Allergies
Student 2 - Health Concerns
Student 2 - Special Needs
PARENT INFORMATION
*
Parent/Guardian 1 - First Name
*
Parent/Guardian 1 - Last Name
*
Parent/Guardian 1 - Email Address
*
Parent/Guardian 1 - Cell Phone
*
Parent/Guardian 1 - Address
*
Parent/Guardian 1 - City
*
Parent/Guardian 1 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Parent/Guardian 1 - Zip Code
Parent/Guardian 1 - Home Phone
Is there a second Parent/Guardian?
Please Select One
Yes
No
*
Parent/Guardian 2 - First Name
*
Parent/Guardian 2 - Last Name
*
Parent/Guardian 2 - Email Address
*
Parent/Guardian 2 - Cell Phone
Does parent/Guardian 2 live at the same address as Parent/Guardian 1?
Please Select One
Yes
No
Parent/Guardian 2 - Address
Parent/Guardian 2 - City
Parent/Guardian 2 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Parent/Guardian 2 - Zip Code
Parent/Guardian 2 - Home Phone
MEDICAL INFORMATION
Physician Name:
Phone Number:
Insurance Company:
Policy / ID#:
EMERGENCY CONTACT INFORMATION
Please list two persons other than parents that can be contacted in the event of an emergency.
*
Emergency Contact 1 - Name
*
Emergency Contact 1 - Phone Number
*
Emergency Contact 1 - Relationship to Student
Emergency Contact 1 - My child(ren) may be released to this person.
Emergency Contact 1 - My child(ren) may be released to this person.
*
Emergency Contact 2 - Name
*
Emergency Contact 2 - Phone Number
*
Emergency Contact 2 - Relationship to Student
Emergency Contact 2 - My child(ren) may be released to this person.
Emergency Contact 2 - My child(ren) may be released to this person.
RELEASE INFORMATION
*
Please check to confirm all boxes below:
Press Release: I grant the Gesher Program of Temple Anshe Hesed permission to take photographs / videos of my child(ren) in connection with Gesher School events. I agree that Temple Anshe Hesed Gesher Program may use this consent for such purposes as news
Medical Release: In the event of a medical emergency or injury, I authorize Temple Anshe Hesed to administer First Aid and/or transport for my child(ren)
Activities Release: I authorize my child to participate in any activity, including added activities not on the itinerary without prior notice.
Total Fees
Sat, July 27 2024 21 Tammuz 5784