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Camper Application
Home
Camper Resources
Camper Application
Registration opens after the Feast of Tabernacles.
Name
*
First
Last
Gender
*
Male
Female
Current Age
*
Date of Birth
*
MM
DD
YYYY
Home Congregation (if applicable)
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
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Bahrain
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Belgium
Belize
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Bolivia
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Chile
China
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Congo, Republic of the
Costa Rica
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Myanmar
Namibia
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New Zealand
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Niger
Nigeria
Northern Mariana Islands
Norway
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Pakistan
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Palestine, State of
Panama
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Sudan, South
Suriname
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Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone Number
Email Address
*
Do you play an instrument or lead dance?
*
I play an instrument
I lead dance
I can play an instrument and/or lead dance
No, I do not play an instrument or lead dance
If you play an instrument please specify which one below. If you aren't a musician or singer, you will be placed on the dance team to help us with different activities.
Name of Parent/Guardian
*
First
Last
Parent/Guardian Main Contact Phone
*
Parent/Guardian Work Phone
Parent/Guardian Cell Phone
Parent/Guardian Email Address
*
Other Emergency Contact & Phone Number(s):
Please list any medical conditions or health concerns that our staff should be aware of:
Please list any allergies to food, medication, animals, or plants/insect bites:
Please list any diet restrictions:
Please list any prescription medication being taken:
Media Release Permission
*
I hereby authorize HRTWAM (Hebrew Roots Teens With A Mission) personnel to take my child’s photograph/video during camp or their participation in any teaching/activity sessions. I hereby release the photograph/video to HRTWAM (Hebrew Roots Teens With A Mission) in promotional materials or other official publications:
As Parent/Guardian I DO authorize HRTWAM staff
As Parent/Guardian I DO NOT authorize HRTWAM staff
Parent Release Permission
*
I hereby authorize the HRTWAM (Hebrew Roots Teens With A Mission) to secure medical services as may be deemed necessary for my child’s health and safety. I will be informed immediately of any medical services that are required. I release HRTWAM (Hebrew Roots Teens With A Mission) and anyone connected with it from any and all liability claims resulting from illness, accident, and/or misfortune:
As Parent/Guardian I DO authorize HRTWAM staff
As Parent/Guardian I DO NOT authorize HRTWAM staff
Camper Essay
*
Please write a paragraph for us, telling us about yourself, your personal walk with our Creator, why you wish to participate in HRTWAM Camp mission’s trip, what you are hoping to accomplish, and how you hope to benefit from it:
Will You Need A Sponsor?
*
The HRTWAM camp cost $670 per camper. Sponsorship is available to those who aren’t able to raise the full amount. Please indicate below the amount you will be contributing towards your camp fee. Your contribution will be applied as a scholarship toward the balance of your camp fee. 100% of your contributions go to paying for the camp cost. Please send the fee before camp to HRTWAM P.O. Box 2008 Homer, AK 99603. Each camper is also responsible for the cost of airfare to and from San Jose, Costa Rica.
No, I do not need a sponsor to help cover my camp costs
Yes, I will need a sponsor to help cover my camp costs
Please indicate the amount you will contribute towards your camp fee:
*
Email
This field is for validation purposes and should be left unchanged.