A Night of Light

Information Details

First Name *

Last Name *

Parent Information Please fill out all parent information. If Parent is a single parent please enter NA.

Mother's Name *

Mother's Cell Phone Number *

Mother's Email *

Father's Name *

Father's Cell Phone Number *

Father's Email *

Are the natural parents of the child Jewish? *

Both Parents

Mother Only

Father Only

Are there any conversions in the family (e.g., the child, parents, grandparents)? *

If yes, please explain and indicate which synagogue the conversion took place:

Camper's Information

Camper's Full Name *

Camper's Jewish Name

Camper's Address *

Camper's Birth Date *

Gender *

Male

Female

Grade Entering September 2026 *

All Sizes are Youth

T-Shirt Size *

XS

S

M

L

How did you hear about camp?

Email to send confirmation

Email *