Register - JewishVail.com

Camper Information
Camper's Full Name*
First Name Last Name
Date of Birth*

Month Day Year
Grade Entering*
Name of School attended in 2023-2024
Is There Anything Special That We Should Know About Your Child (Allergies, etc)?
Parent Information
Father's Full Name*
First Name Last Name
Mother's Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*

Address*

Emergency Information
Emergency Contact #1 Name*
First Name Last Name
Emergency Contact #1 Number*

Area Code Phone Number
Emergency Contact #2 Name*
First Name Last Name
Emergency Contact #2 Number*

Area Code Phone Number
Primary Doctor*
Doctor's Phone Number*

Area Code Phone Number
Allergy Information
Permission
Camp Weeks Attending*

7/8 - 7/12 - WAITLIST7/15 - 7/19 - WAITLIST7/8 - 7/12 I am an Aleph Art Room Member - WAITLIST7/15 - 7/19 I am an Aleph Art Room Member - WAITLIST
Total

$0.00
Please consider making a donation to support covering camp costs
I hereby permit my child(ren) to participate in all activities at Basecamp Vail – on site, off-site and trips and be transported to and from the field trips and outings. I release Basecamp Vail and individuals from liability in case of accident during activities related to Basecamp Vail, as long as normal safety procedures have been taken. I understand that my child(ren) may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision.
Permission*

I Permit

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Camper Information