Shalom Institute Family Camp 2012 Registration Form
Please complete and submit all below information. If you have any questions, please contact us at 818.889.5500.
 
When: May 11th - 13th 2012         
Where:The Shalom Institute in Malibu!
Fees: Adults ($170/person), Adult in Private Room ($205/person), Children 4 and up ($130/person), Children 3 and under (Free!)
 
Personal Information
Family Name:
Address:
City:
State:
Zip:
Home Phone:
 Work Phone:
Cell Phone:
 Email:
 
($170 Each)
($130 Each; Children Under Four FREE)                  
 
Standard accommodation includes multi-occupancy cabin, or in your personal RV or tent. Private Motel-style rooms are available on a first-serve basis, for an additional charge of $35.00 per Adult.
 
 
*Important Note: Emma Stern rooms are based on double occupancy. If you are a single parent and would like a private room, please call the office at 818.889.5500 and ask to speak with Hagit Marciano.
Please indicate any special medical needs:
   
Please indicate any special dietary needs:
(i.e. vegetarian, vegan, food allergies)
*note: all meals are kosher*
   
Please indicate any other needs:
(i.e. high chair, wheelchair, special care, etc.)
   
Does your family have any special occasions
this weekend? (i.e. birthday, anniversary, etc)
   
If there is an emergency while you are here
at camp, please fill out whom you would
like us to contact. (i.e. relative, grandparents)
Name: Relation: Phone:
   
Would you like an extra bed in your room in case your child decides NOT to sleep in their cabin at the last minute?
Yes   No
Attendees:     Total:   $ 
 

Please verify your information and click below to submit your reservation.

PLEASE NOTE:
Your reservation will not be complete until you submit a $100.00 registration deposit. Payments can be accepted via credit card over the phone at 818.889.5500, or you can mail-in a check to our office. The balance will be charged on 4.20.12