New Camper Request Application Form 2025

The process for applying as a mothers helper is as follows:

Applications for mother's helper positions are handled similarly to regular camper applications. Mother's helpers who are camper age pay $800 plus $300, $150 tip and $150 canteen. We will charge a $400 deposit upon acceptance. If you choose to decline the spot you have 48 hours to get a full refund. After that we assume you will be taking the spot. We will then email you the final forms to fill out.

First Name (Camper) *

Last Name *

Date of Birth * +

Current Grade *

Current School *

Trip Requesting *

Camp Dates:

Trip 1 - July 1st - July 28th

Trip 2 - July 30th - August 25th

When you sign up for camp, you are committing to ensure that your daughter is able to stay from beginning to end and no other obligations (i.e family trips, etc.) will conflict.

Have you ever attended Chaviva ? *

Yes

If yes, which year(s)?

Name of Camp attended last year *

Have any sisters ever attended Chaviva ? *

Yes

Primary Email Address *

Father Title

Father (First Name Only)

Father's Cell Phone

Mother Title

Mother (First Name Only)

Mother's Cell Phone

Marital Status *

Secondary Email Address

Address *

City *

State *

Zip *

Home Phone
(If you do not have a home phone
write N/A, do not use cell number) *

Father's Occupation

Father's Firm Name

Father's Business Phone

Mother's Occupation

Mother's Firm Name

Mother's Business Phone

Mother's Maiden Name *

Shul Affiliation *

Emergency Contact Name *

Emergency Contact Phone *

Siblings (Please list all names of younger siblings and include their ages) *

Has any family member attended Camp Chaviva previously? Please include names.

Do you spend your summer in the mountains? If Yes, which Bungalow Colony or Address? If No, write N/A *

If the trip you selected is not available would
you be willing to switch to the other trip?
This question is extremely important. Please answer accurately as it may determine your acceptance. *

Yes

Who do you know in Camp Chaviva?

IMPORTANT - Acceptance depends on this: Before a camper is accepted, we will contact references and she must meet the approval of our head staff. Please provide names and phone numbers of two of her last year's Mechanchos/Home Room/Limudei Kodesh Teachers, who know your daughter well. It is important that you provide the private numbers of the teachers (preferably cell phone). If the school number is given, it may delay (or derail) the process.

Name (1) *

Cell Phone (1) *

Job Position (1) *

Name (2) *

Cell Phone (2) *

Job Position (2) *

Are you applying with any friends? If yes, what are their names.

Will you only come to camp if your friends, cousins, etc are accepted?
*

Yes (I will only come if my friends/cousin are accepted)

No (I will still come if my friends/cousin aren't accepted)

Upon acceptance into camp by receiving an acceptance email, I understand my card will be charged the deposit amount of $400 for a mothers helper. I then have 48 hours to deny the spot for a full refund. After this time the regular cancellation policy applies. *

Yes

Credit Card Number *

Expiration Date (MMYY) Just 4 Digits NO / *

Billing Zip Code *

CVV Code *

Memo (Please include any work experience and references if applicable)