Camp & School Intake Form

PARENT/GUARDIAN 1 INFORMATION

Parent/Guardian 1 - First Name

Parent/Guardian 1 - Last Name

Parent/Guardian 1 - Email

Parent/Guardian 1 - Mobile

Parent/Guardian 1 - Address

Parent/Guardian 1 - City

Parent/Guardian 1 - State

Parent/Guardian 1 - Zip Code

* Is there a second Parent/Guardian?

PARENT/GUARDIAN 2 INFORMATION

Parent/Guardian 2 - First Name

Parent/Guardian 2 - Last Name

Parent/Guardian 2 - Email

Parent/Guardian 2 - Mobile

Does Parent/Guardian 2 live at the same address?

Parent/Guardian 2 - Address

Parent/Guardian 2 - City

Parent/Guardian 2 - State

Parent/Guardian 2 - Zip Code

CHILD(REN)'S INFORMATION

How many children are being registered?

Child 1 - First Name

Child 1 - Last Name

Child 1 - Date of Birth

Child 1 - Gender

Child 2 - First Name

Child 2 - Last Name

Child 2 - Date of Birth

Child 2 - Gender

Child 3 - First Name

Child 3 - Last Name

Child 3 - Date of Birth

Child 3 - Gender

Interest Selection (select all that apply):

Camp KayetzSimcha PreschoolTemple School

Tue, January 21 2025 21 Tevet 5785

Temple Beth El - Jewish Community Center of Santa Cruz

3055 Porter Gulch Road, Aptos, CA 95003 (831) 479-3444

Tax ID 94-6139655