daycamp "*" indicates required fields Do you live in Bergen County?* Yes No Scholarships are only available for children who reside in Bergen County. This field is hidden when viewing the formDo you live in Bergen County? Yes No Scholarships are only available for children who reside in Bergen County. Child's Name (Scholarship Applicant)* First Last School Child is Currently Attending*What Camp will your Child be Attending?*Will Your Child be Attending One or Two Sessions of Camp?* 1 Session 2 Sessions Full Price of Camp*Have you asked the camp for a scholarship?* Yes No If Yes, what is your current obligation?How much can you contribute to day camp for this child?*Parent #1's Name* First Last Parent #1's Cell Phone Number*Parent #1's Email Address* Parent #1's Occupation*Parent #2's Name First Last Parent #2's Cell Phone NumberParent #2's Email Address Parent #2's Occupation*Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Total Number of Household Members Living at Home*Names and ages of all school aged children up to the age of 18*What camps will those children be attending?*Total Dollar Amount Currently in your Checking Account(s)*Total Dollar Amount Currently in your Savings Account(s)*Total Household Monthly Take-Home (Net) Pay*What is your monthly rent/ mortgage payment?*What is your total annual tuition obligation for all of the children in your household?*Name of Family Rabbi*Phone Number or Email of Family Rabbi*We give permission to Project Ezrah to speak with our Rabbi* Yes Are you receiving any other forms of assistance (ie Tomchei Shabbos, School Scholarships etc. Note: You are still likely eligible for funds, even if you do receive from other sources) If yes please explain. **Is there anything else you would like us to know about?* Δ