Grief & Growing Registration Process:
Once you register, you will receive a participant packet to help you prepare for camp. Someone will contact you soon.
Grief & Growing Registration Form Instructions:
This is a secure page. Please fill in all appropriate information for those who are attending camp with you. You may leave some fields blank. There is room on the form for 4 Adults and 4 Children. If you experience problems with this form, please email us or call (415) 750-3436. Click here for our Refund Policy.

Note: You must enter your credit card information to submit this form, even if you are applying for a scholarship. Please contact Bay Area Jewish Healing Center for other payment options via email or call (415) 750-3436.

Grief and Growing Camp Registration Form



Adult #1

First Name
Last Name
Gender Male Female
Birth Date / /
Home Address
City
State
Zip
Evening Phone
Day Phone
Email
Relationship to participating children
Relationship to person(s) who died


Adult #2

First Name
Last Name
Gender Male Female
Birth Date / /
Home Address
City
State
Zip
Evening Phone
Day Phone
Email
Relationship to participating children
Relationship to person(s) who died


Adult #3

First Name
Last Name
Gender Male Female
Birth Date / /
Home Address
City
State
Zip
Evening Phone
Day Phone
Email
Relationship to participating children
Relationship to person(s) who died


Adult #4

First Name
Last Name
Gender Male Female
Birth Date / /
Home Address
City
State
Zip
Evening Phone
Day Phone
Email
Relationship to participating children
Relationship to person(s) who died


Child # 1

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2012


Child # 2

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2012


Child # 3

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2012


Child # 4

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2012


Payment Information

Adults @ $350 each = $
0 $
Children (under 3) @ $150 each = $
TOTAL COST: $


Please charge my fees to a credit card:
Card Type
Name on Card:
Card Number:
Exp. Date /


Please contact me to discuss financial options. I have enclosed a deposit of $100 to hold my space.

A participant packet will be sent to you after we receive your registration.

REFUND POLICY: A full refund will be granted if Bay Area Jewish Healing Center is contacted before August 12, 2011 by 5:00pm. No refunds will be granted for cancellations on or after August 14, 2011.Contact us.