Beth Torah ECA Mini Camp 2023

* Camper First Name

* Camper Last Name

Gender

MaleFemale

Grade (2023/2024)

Pre-Toddler - Children between 12 & 18 monthsToddlers & 2's - Children entering Toddlers or PK2 in the fallKiddie Camp - Children entering PK3 in the fallJunior Kindergarten - Children entering PK4 in the fall

* Address

* City

* State

* Zip

* Parent's Name

Parent's Cell Phone Number

* 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

Total

* Parent's Signature

Sat, June 3 2023 14 Sivan 5783