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 2008


Child # 2

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2008


Child # 3

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2008


Child # 4

First Name
Last Name
Gender Male Female
Birth Date / /
Grade in Fall 2008


Payment Information

Adults @ $245 each = $
Youth (over 3) @ $180 each = $
Children (under 3) @ $110 each = $
TOTAL COST: $


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


Please send a Reduced Fees Application. I have enclosed a deposit of $100 to hold my space. Full payment is due upon receipt of invoice which will be sent with your participant packet.

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

REFUND POLICY: A full refund, less deposit, will be granted if Bay Area Jewish Healing Center is contacted before August 31, 2008 by 5:00pm. No refunds will be granted for cancellations on or after September 1, 2008. Contact us.