Ezra Junior Boys Summer Camp 2022
WAITING LIST APPLICATIONS ONLY

Completing years 4-6
Camp Venue: Stoke On Trent
Dates: 11- 24 August
Cost: The full price of Junior Boys Summer Camp is £825
This includes transport TO AND FROM CAMP FROM PAI HOUSE NW11


How to apply
- Complete the form below on behalf of your son
- Settle a non refundable deposit of £200

We will confirm if your son has a place at camp or is on the waiting list by 15 May.

If your son does not receive a place at camp his deposit will be refunded.

Places at camp may not be given on a first come first served basis. Regular attendees of Ezra groups may be given priority.

If you complete a form and then decide you no longer require a place at camp before you have paid a deposit, please email admin@ezrayouth.com to delete your form.

Applications made after 6 June 2022 will incur an additional £30 admin fee.

Applicants who live abroad may apply for camp after 20 May 2022 if there are still spaces available.

Ezra UK reserves the right to refuse any application if they decide the applicant is not suitable for camp.

Please see www.ezrayouth.com for further details or email camps@ezrayouth.com with queries
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Chanich First Name *
Surname *
Nationality *
My child, named above does not live in the UK but speaks fluent English. I understand that his application will not be processed until after 20 May 2022. *
Date of Birth *
MM
/
DD
/
YYYY
Age *
School Year *
Name of School *
By completing this application I give Ezra permission to discuss details of my child's application with the school below.
Contact number of School *
Home Address *
Post Code *
Country *
Home Phone Number *
Parent name *
Parent email address 1 *
All camp correspondence will be sent to this email. Please check that there are no spelling mistakes and ensure that this is an address which is checked regularly.
Parent email address 2
If you would like camp correspondence to be sent to a second email address as well please provide it here. Please check that there are no spelling mistakes.
Parent contact number - for contact before camp *
Name of Emergency contact 1 - for emergencies during camp *
Emergency contact number 1 *
Name of Emergency contact 2 - for emergencies during camp *
Emergency contact number 2 *
Medical Information / Allergies *
Please provide information of any medical conditions / allergies / dietary allergies or requirements
Additional Medical Information *
If your child has any educational, behavioral or eating disorders or has either been referred for, or has had any counselling or therapy within the last 6 months. please indicate below so that we can discuss further.
GP Name and Number *
Name of Shul *
Name of Family Rabbi *
Contact Number of Family Rabbi *
For reference
Name and Contact Number of Teacher *
For reference
I would like to book for Ezra Junior Boys Camp 2022 and will make a non refundable deposit of £200 to confirm my booking. *
All payments must be made by online bank transfer.  Account Name: Ezra Youth Movement, Account Number:00006407, Sort Code:30 93 50. Please use reference first name, surname, reference code (SJB) e.g. NameNameSJB
I give permission for Ezra Youth Movement to take pictures of my child during this trip to use for promotional purposes. *
I grant permission for Ezra Youth to take any necessary action during camp should there be any unforeseen occurrences be it medical or other. *
I am happy for Ezra Youth to send me information about future Ezra Camps. (To join the Ezra Parent database please sign up here https://forms.gle/mUiqQ1fiVs1mdobh8) *
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