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Beth Torah ECA Mini Camp 2023
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Camper First Name
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Camper Last Name
Gender
Male
Female
Grade (2023/2024)
Pre-Toddler - Children between 12 & 18 months
Toddlers & 2's - Children entering Toddlers or PK2 in the fall
Kiddie Camp - Children entering PK3 in the fall
Junior Kindergarten - Children entering PK4 in the fall
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Address
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City
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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
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip
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Parent's Name
Parent's Cell Phone Number
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Parent Email
Emergency Contact
Emergency Contact Phone Number
Does your child have any allergies?
Is your child on any medications?
Please include any immportant information about your child
Program
ECA Summer Mini Camp - 4 Days
Total
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Parent's Signature
Sun, September 8 2024 5 Elul 5784