Registration forms 2021-01-11T15:23:30+00:00

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Ruach Registration
Penina Registration

Ruach Registration

Please note that there will be a 3% charge added to each payment made with a credit card. If you prefer to pay by check or cash, please notate that in the “Notes” box below. We will hold your application for one week from the date submitted, during which time you can drop off the deposit in our camp office. Alternatively, you can email us at for a local location to drop off your payment.

*Required Fields

Camper 1


Whole SummerFirst TripSecond TripOther

Bunk Request

Camper 2


Whole SummerFirst TripSecond TripOther

Bunk Request

Camper 3


Whole SummerFirst TripSecond TripOther

Bunk Request

Camper 4


Whole SummerFirst TripSecond TripOther

Bunk Request


Parental Status

MarriedDivorcedDeceased FatherDeceased Mother

Father's Name*
Father's cell*
Father's Business Telephone
Father's Email Address*
Father's Address*

Mother's Name*
Mother's cell*
Mother's Business Telephone
Mother's Email address*
Mother's Address*

Home telephone*

Emergency Contacts

contact 1

contact 2


Bus Information

A.M. Exact Pickup Location

P.M. Exact Pickup Location

No Bus Transportation



In the event of a medical emergency I hereby give authority to Ruach Day Camp staff to obtain necessary medical treatment for my child/children:

Ruach Daycamp and their staff shall be held harmless from any and all liabilities arising from emergency.

I understand that any belongings left at the end of the summer may be donated to tzedaka.

The camp administration reserves the discretionary right to require the withdrawal of any camper for disciplinary or educational reasons. I will incur a minimum of $100 plus pro-rated charge for amounts of days in camp.

I will be held liable for any and all damages incurred by my child(ren).

Tuition must be paid in full prior to June 1st. Any outstanding balance will terminate my child's admission to camp

I fully understand that I will receive a full refund if I cancel before June 1st. I will receive no refunds for any other absences or cancellations.

It is not the camp's responsibility to collect from other sources, scholarships, sponsorships, or vouchers, beyond normal billing.

I agree to send my children on all camp trips with transportation provided.

I hereby certify that the information given in this application is complete and true, and agree to all the points stated above.


Please enter your credit card in order for us to hold a spot for you child(ren).

Deposit amount:
$400 deposit per child for full summer
$150 deposit per child for half a summer
Your credit card will be charged within a few days of submission.


The balance for the summer is due in full by June 1st


Total due after deposit:*

Please choose one from the following*:

Please charge entire amount upon receipt of applicationBalance will be paid by check/cashEnter credit card payment plan

Credit Card for Payments

Use same credit card written aboveEnter new credit card

How did you hear about us?*

Penina Registration