Ready to sign up? Get it done in 3 easy steps and you're on way to an UNbelievable summer. 1. Fill out the application below. (Mom and Dad, this is your daughter's job) 2. Make sure to have the name, email and number of the person who's going to write your recommendation: a teacher, mentor, employer, counselor or anyone who knows you well. 3. Pay your $50 sign up fee and receive an email confirmation from us. If you need scholarship help, make sure to check that off on the application, then watch your inbox for instructions. Please don't book your ticket until you get your acceptance email from us. If you have questions or need help, we'd love to talk to you! Jewish UnCamp Summer Application Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Page 1 Contact Information First Name Middle Name Last Name What is your nickname, or, what do you like to be called? (If it's the same as your first name, please enter your first name in the field below. Example: Sarah) Date of Birth Cell Phone Home Phone Preferred Phone NumberPlease select... Home Cell Facebook Name Email Address What's the best way to contact you?Please select... Text Call Email Facebook WhatsApp What's the second best way to contact you?Please select... Text Call Email Facebook WhatsApp Hebrew name, if known Mother's Hebrew Name, if known Permanent Address Street City U.S. StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PR VI Northern Mariana Islands Guam American Samoa Palau Postal Code CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe State/Province if outside of the United States School Information Full Name of School Your grade this past yearPlease select... 8th 9th 10th 11th 12th Graduate School Contact Person School Phone Parent/Guardian Information Father's First Name Father's Last Name Father's Cell Phone Father's Email Mother First Name Mother Last Name Mother Cell Phone Mother's Email Would you prefer to enter a Guardian?Yes, Please Guardian's Name Relationship to you Guardian's Phone Guardian's Email Parent's Marital StatusPlease select... Married Divorced Widowed Separated Single Who should we contact about payment?Please select... Me Mother Father Guardian Referral Information How and where did you hear about the Jewish UnCamp? Friend Family Facebook Online SearchCTeen LeaderCTeen Shabbaton I’m an Alum!NCSYTeacherChabad HouseSchool Other If other, please provide details: If you heard about us from a family member, friend or teacher, please provide the information below. Referral First Name Referral Last Name Referral Phone Referral Email Would you like to add a referral name?Yes, please Ref 2 First Name Ref 2 Last Name Ref 2 Cell Number Ref 2 Email Scholarship Information Do you need a scholarship in order to attend? If yes, you’ll receive a link to the scholarship form by email.YesNo Who is the best person to contact about this?Please select... Father Mother Guardian What is the best way to contact this person?Please select... Home Phone Cell Text Email Sister & Friends Information Any Friends or Sisters Registering?Please select... Yes No Sister or Friend Name Sister or Friend Number Emergency Contact Information Please provide 2 emergency contacts. Contact Name (1) Relationship (1) Cell Phone (1) Contact Name (2) Relationship (2) Cell Phone (2) Page 2 Help us get to know you What are your special interests and talents? (music, sports, drama, debate, politics, etc.) What are you most looking forward to? Is there anything else you want us to know about you? Page 3 Medical Information Do you have any medical, dietary, or other needs? Do you have any allergies, including penicillin? Please list any medications you’ll be taking during the trip. If there are none write none. Do you have any restrictions on activities? If so, please explain. Recommendation Information Please provide the name and contact information for the person who is going to write your letter of recommendation, such as a teacher, employer, or adult friend (not your parent). We'll email this person directly to request the recommendation. First Name of Recommendation Last Name of Recommendation Phone Email I give permission to Bais Chana Women International to use photos, written quotes, audio or video of me in their promotional materials or for other non-profit purposes.Please select... Yes No Page 4 Next you will have the opportunity to review your application. When you click confirm, you will be directed to the payment page. Have your credit card ready, your $50 application fee must be paid now in order for your application to be complete. You can also make full or partial payment on the program and bus fees. Summer UnCamp Fees Application Fee - $50 (Must be paid with your application in order for it to be complete)Program Fee - $2,999Transportation (from airport to campsite, and return) - $80 (Must be paid before camp in order to reserve a seat on the bus)If you need a deferred payment plan, please email firstname.lastname@example.org or call 718.604.0088.If you checked Yes to the Scholarship question, you will receive the Scholarship Application by email. reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Save my progress and resume later | Resume a previously saved form Need assistance with this form?