Calling all Jewish Teen Girls! Sign up for WEEK 2 of Virtual Uncamp here! Or try it out with a ONE-DAY PASS! 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. Submit and pay. If you have a discount code, enter at the top of the page. Select Wk 2 or a One-Day Pass.Need a discount code? payment plan? Scholarship? Email teens @jewishuncamp.org 3. Get ready for a life-changing summer with your new best friends from around the world! If you have questions or need help, we'd love to talk! Call us at 718-604-0088 or email teens @jewishuncamp. org. Virtual 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 Last Name Date of Birth (mm/dd/yyyy) mm/dd/yyyy Cell Phone Email Address (Camper email only) ***WARNING*** Only put CAMPER's email address in this field. NOT parent's email address. 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 Parent/Guardian Information First Name Last Name Cell Phone Email Relationship to you Referral Information How and where did you hear about the Jewish UnCamp? Friend Family Facebook Online SearchCTeen LeaderCTeen Shabbaton I’m an Alum!Jewish Youth Group (like USY, BBYO, NCSY, etc.)TeacherChabad 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 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? I'd like to sign up for:Session 1: Monday, June 29 - Friday, July 3 Session 2: Monday, July 6 - Friday, July 10 Both Sessions 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 Contact Information
