New Camper Request Application Form 2024

If you are applying more than one camper please fill out a separate form for each child.

First Name (Camper) *

Last Name *

Date of Birth * +

Current Grade *

Trip Requesting *

Have any sisters ever attended Chaviva ? *

Yes

No

Name of Camp attended last year *

Current School *

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

No

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 $850. This will be applied towards my final camp fee. 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 add any information you would like for us to know)