Camp Barney Medintz:

Family Camp Weekend Registration

Family Information

Family Name
Mom's Name, Birthdate
Mom's Mobile Number, Occupation
Dad's Name, Birthdate
Dad's Mobile Number, Occupation
Child(ren)'s Name, Birthdate, Gender
Street Address
City
State
Zip
Email address
We would like to share a cabin with
Accommodation first preference:
Accommodation second preference:
Has your child previously attended a Camp Session at CBM?
 Yes
 No
Family birthday or anniversary during weekend? Date?
Special dietary needs:
2018 will be our ? year at Family Camp!
Your family is:
 MJCCA Member
 Other JCC Member
 Community/Non-Member

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