Hertz Camp Registration 2023 - Form - Temple Israel of Sharon

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Hertz Camp Registration 2023

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The toddler program for the summer is nearly full.
You may receive an email from the directors if you've been placed on a waitlist.
For further questions, please email Leisa Glass and Shayna Yarmush.

* How many children will be attending Hertz Camp?

indicate the number of children attending1234

* 1: Child's Name (First and Last)

1: Child's Nickname

* 1: Date of Birth

1: Child's Hebrew Name (if applicable)

You can type in English or use the Hebrew keyboard pop-up

* Child 1:

Does your child have any allergies? ANSWER REQUIREDNoYes

Child 1: Please select all that apply to your child:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfish

Child 1: Other Allergies or Drug Allergies:

Child 1: Does your child require an epi-pen for any of the allergies you have selected?

Child 1: Please select allergies for which child needs an epi-pen:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfishOther

* 2: Child's Name (First and Last)

2: Child's Nickname

* Child 2: Date of Birth

2: Child's Hebrew Name (if applicable)

You can type in English or use the Hebrew keyboard pop-up

* Child 2:

Does your child have any allergies? ANSWER REQUIREDNoYes

Child 2: Please select all that apply to your child:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfish

Child 2: Other Allergies or Drug Allergies:

Child 2: Does your child require an epi-pen for any of the allergies you have selected?

Child 2: Please select allergies for which child needs an epi-pen:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfishOther

* 3: Child's Name (First and Last)

3: Child's Nickname

* Child 3: Date of Birth

3: Child's Hebrew Name (if applicable)

You can type in English or use the Hebrew keyboard pop-up

* Child 3:

Does your child have any allergies? ANSWER REQUIREDNoYes

Child 3: Please select all that apply to your child:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfish

Child 3: Other Allergies or Drug Allergies:

Child 3: Does your child require an epi-pen for any of the allergies you have selected?

Child 3: Please select allergies for which child needs an epi-pen:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfishOther

* 4: Child's Name (First and Last)

4: Child's Nickname

* Child 4: Date of Birth

4: Child's Hebrew Name (if applicable)

You can type in English or use the Hebrew keyboard pop-up

* Child 4:

Does your child have any allergies? ANSWER REQUIREDNoYes

Child 4: Please select all that apply to your child:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfish

Child 4: Other Allergies or Drug Allergies:

Child 4: Does your child require an epi-pen for any of the allergies you have selected?

Child 4: Please select allergies for which child needs an epi-pen:

Tree NutsPeanutsEggsMilkGluten/WheatSoybeansFishShellfishOther

* Child(ren)'s Street Address 1

Child(ren)'s Street Address 2

* State

* City

* Zip Code

Parent 1 Information

* Parent 1: First Name

* Parent 1: Last Name

* Parent 1: Cell Phone

* Parent 1 Email

Parent 1 has the same address as Child

Street Address 1

Street Address 2

City

State

Zip Code

Parent 2 Information

Parent 2: First Name

Parent 2: Last Name

Parent 2: Cell Phone

Parent 2 Email

Parent 2 has the same address as Child

Street Address 1

Street Address 2

City

State

Zip Code

Total Registration Fees for Camp

Fri, April 19 2024 11 Nisan 5784

Temple Israel
PO Box 377 | 125 Pond Street
Sharon, MA 02067
781-784-3986 | info@tisharon.org

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