The Camp Koby Mandell Summer in Israel Experience

                                               Application 2011

 Please fill out all fields
Personal Information
First Name (as in passport)                              Last Name                                                       Middle                                                              Hebrew Name
         
  Address                                                            City                                        State                                  ZIP                         Gender
                   Male   Female 
Home Phone                                   Cell Phone                                          Personal Email                                                  
                
Level of spoken Hebrew                                  Birth Date
                                                
Passport #                                         Exp  Date                                            Citizenship 
                                                     
Camps in Previous Summers:
Summer of 2010:                                               Summer of 2009:                                                   Summer 2008:
                 
Family Information
Father
 First Name                                                          Last Name                                                       Middle
          
 Address (if different from above)                City                                        State                                  ZIP 
                  
Day  Phone                                       Mobile Phone                                  Occupation                                                           Father's Email 
                
Mother
 First Name                                                         Last Name                                                       Middle
          
 Address (if different from above)                City                                        State                                  ZIP 
                  
Day  Phone                                       Mobile Phone                                  Occupation                                                          Mother's Email 
                
EMERGENCY Contact
USA/Canada
First Name                                                          Last Name                                                       Middle
          
Day  Phone                                       Mobile Phone                                  Relationship 
                
Israel
First Name                                                          Last Name                                                       Middle
          
Day  Phone                                       Mobile Phone                                  Relationship 
                
Affiliation
School                                                                       Grade  
       Entering 11th grade in Sep. 2011            Entering 12th grade in Sep. 2011 
Synagogue                                                     Name of Rabbi
                
Digital Signature (Retype your name and date to sign digitally)
By signing this contract, I certify that my child is eligible to attend the The Koby Mandell Foundation Summer in Israel Experience without reservations, and I agree to pay the fee listed. I agree to pay for any property damages that might be caused by my child. Registration fee is $200 US.
Parent's Signature                                                 Camper's signature                                          Date 
            
  HOW TO APPLY

1.  Click on the SUBMIT button below.
2.   By clicking you will send us the information on this form electronically.
3.   Please click here to
and send the printed application along with a $200.00 application fee (payable to Camp Koby Summer Program)
4.   Please mail (to address below) 2 recent passport photos or email recent photo to summer@kobymandell.org 
5.   
Send 2 letters of recommendation – Recommendation letters can either be filled out online or printed out  from this link. Please email link to the person giving the recommendation (click here to send email with link) or give them a printed version to be sent by mail. One of the letters must be from a current Judaic Studies Teacher.

Upon receipt of your application you will be notified of an interview date. You may also be invited to a further group workshop interview. 

Upon acceptance to the program you will be notified of the payment schedule and other information. 

  

Please forward all correspondence to
NOTE: NEW ADDRESS: 
Rabbi Dovid Kupinsky
The Koby Mandell Foundation
366 Pearsall Avenue
SUITE 1
Cedarhurst, NY 11516
(301) 576-6235
dovid@kobymandell.org

If you have trouble submitting you can fax to (206) 350-7467