ZinkerzCamp | College Journey S'23

Parent Name*

First Name Last Name
Parent Email*
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Parent Phone*

Country Code Phone Number
Student Name*

First Name Last Name
Student Email*
example@example.com
Student Phone*

Country Code Phone Number
Date of Birth*

MonthDay Year
Passport Copy*

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Expiration Date*

MonthDay Year
Country*
What is your T-Shirt Size?*

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Arrival & Departure Info

If you have purchased your flight tickets please provide us with the details. If you have not, please let us know as well.
I don't have my flight tickets yet.
No worries! You'll be able to submit your flight itinerary after registering.
Arrival Flight (Boston inbound Flight only)

Students are asked to arrive on July 5th, 2023 between 10:00am and 6:00pm to ensure shuttle service from the airport or train station.
Airline
Flight Number
From
To
Flight Date & Time

MonthDay Year
Date
Hour Minutes AM/PM Option
Departure Flight (Boston outbound Flight only)
Airline
Flight Number
From
To
Flight Date & Time

MonthDay Year
Date
Hour Minutes AM/PM Option
Roomate Requests?

We will do our best to honor these requests
Please list any special requests about rooming:
Roommate #1

First Name Last Name
Roommate #2

First Name Last Name
Roommate #3

First Name Last Name
Activities
Fun Activities: Please indicate which type of activities you'd like to do.

ShoppingHistorical sitesMuseums (art, natural history, science)Food-Oriented (tours, visits to local spots, etc)Boston Favorites (Fenway Park, Boston neighborhoods, Hockey game)Entertainment (movies, comedy shows, music)Sports (rock climbing, ice skating)Recreation (laser tag, escape the room)

College Tours: During ZinkerzCamp, we will have the opportunity to visit some of the colleges and universities in the area. Please rank the following schools in order of your interest

	Very Interested 1	Interested 2	Neutral 3	Less Interested 4	Not Interested 5
Boston University
MIT
Harvard
Brandeis
Babson
Northeastern
Tufts
Brown
Bentley
Dartmouth

Dietary Restrictions
Please select ALL lunch options you would be happy to have during ZinkerzCamp.

SaladPastaPastrami SandwichesAvocado Toast (Egg, Tomato, Toppings)BurgersChicken SandwichChicken FingersRice BowlsBagelsPoke
If you have any other food preferences please list them here.
Do you have any food allergies we should know about?

YesNo
Please specify
Medical
Do you have any health problems, allergies, and/or conditions we should know about?*

YesNo
Please be as specific as possible. It is for your safety. This information will be kept confidential*
Upload Student's Medical Insurance Card with Coverage in the US (front & back)*

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Upload Student's Vaccination Card or Proof of Vaccination*

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Waiver

Please sign below the following Waiver Forms. You will get a copy to your email after submitting.
ZinkerzCamp Waiver
Dormitory Waiver
Student Signature*

Clear
Parent/Guardian Signature*

Clear
In case of emergency, whom should we contact?
Name

First Name Last Name
Relationship to Student
Phone Number of Emergency Contact
Additional Information
Would you like to attend praying services at the local synagogue during Shabbat?

YesNo
Do you have any other special needs, requirements or comments?

YesNo
Please specify*
Payment

Please confirm your attendance by submitting your payment.

ZinkerzCamp: College Journey - Summer 2023

$7,900.00

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Subtotal

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Tax

$0.00

Total

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Arrival & Departure Info

Roomate Requests?

Activities

Dietary Restrictions

Medical

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Additional Information

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