2023 – Camper Registration Questionnaire

2. Date of Birth(Required)

3. Phone(Required)

4. Email(Required)

6. Pronouns

*Pronouns are the part of speech used to refer to someone in the 3 rd person. We want to know how to respectfully refer to you.

Moishe is a learning organization, and we would like to know more about the audience we are serving. Please answer these questions for us to be able to create more programs that would answer your needs and interests.

Other gender:

If you chose yes for the previous question, in which of the following ways did you visit Israel?

Other reason for visiting Israel:

9. Prior to graduating high school, did you participate in any of the following activities?(Required)

Which youth group did you participate?

Other (please specify the group)

Please think about the extent to which you agree with the following statements based on your experience:

25. What brings you to camp?(Required)

26. Vaccination Proof(Required)

Max. file size: 256 MB.

27. Accessibility Requirements

*Please email Elina Kurakin elina.kurakin@moishehouse.org, if you have a physical or mental health disability and need reasonable accommodation in order to participate in the upcoming camp. In your email, please describe the nature, extent and duration of your disability and the accommodations you believe are needed to enable you to participate in this experience. Please ensure that your request is made at least *ONE MONTH BEFORE THE FIRST DAY OF THE CAMP*. Once your request is received, we will engage in an interactive process to determine your needs and identify appropriate effective reasonable accommodation(s). Please note that not all requests can be accommodated, but we will do our best to support you and provide reasonable modifications needed to ensure your success on our upcoming camp.

29. Emergency Contact Phone Number(Required)

Other dietary restrictions:

31. Kashrut Level(Required)

Other kashrut level:

32. Roommate request (if applicable)

33. T-Shirt size(Required)

Ad Title

35. Please specify who told you about camp? (Company, Organization, or Friend Name)(Required)

36. Social Media/Instagram handle: help us connect on social media!

Email

This field is for validation purposes and should be left unchanged.

2023 Camper Information Form