Parent/Guardian

First Name

Last Name

Zip / Postal

Mobile Phone

Would you like to receive texts at this number?

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I would like to add a second adult.

Parent/Guardian 2

First Name

Last Name

Mobile Phone

Would you like to receive texts at this number?

How many children do you have?

Child 1

First Name

Last Name

2025-2026 Grade

Gender

Child 2

First Name

Last Name

2025-2026 Grade

Gender

Child 3

First Name

Last Name

2025-2026 Grade

Gender

Children 4+

Please enter information for any additional children here.

I am interested in learning more about:

URJ Camp Coleman (Atlanta, GA)URJ 6 Points Creative Arts Academy (West Chester, PA)URJ 6 Points Sports Academy (Asheville, NC)

If you are a member of a Reform congregation, which one?

How did you hear about us?

Additional Comments

By submitting this form, you agree to receive information from URJ camps about summer programming.