Parent/Guardian
First Name
Last Name
Email
Phone
Mailing Address 1
Mailing Address 2
City
State
Zip / Postal
I would like to add a second adult.
Parent/Guardian 2
First Name
Last Name
Email
Phone
Mailing address different than parent 1
Mailing Address 1
Mailing Address 2
City
State
Zip / Postal
How many children do you have?
Please select...
1
2
3
4+
Child 1
First Name
Last Name
Grade as of Fall 2022
Please select...
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Please select...
Male
Female
I would like to give more information about my child's gender identity.
Child 2
First Name
Last Name
Grade as of Fall 2022
Please select...
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Please select...
Male
Female
I would like to give more information about my child's gender identity.
Child 3
First Name
Last Name
Grade as of Fall 2022
Please select...
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Please select...
Male
Female
I would like to give more information about my child's gender identity.
Child 4
Please provide information about any additional children here:
I am interested in learning more about:
URJ Camp Harlam (Kunkletown, PA)
URJ 6 Points Sci-Tech Academy East (Byfield, MA)
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?
Please select...
I heard from my congregation.
I heard from my federation.
Someone in my family is a URJ Camp Alum.
I heard from a current camper.
I heard at the URJ Biennial.
I heard at NFTY Convention.
I heard at a NFTY Regional Event.
I heard at a Camp Fair (not at a congregation).
I heard on social media.
I found this website by searching online.
None of these.
Additional Comments
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