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Chabad Winter Camp

1. Child/ren’s Information
Child 1*
First NameMiddle NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Sessions ($150 for the week, $50 per day)*
Full Week 1MondayTuesdayWednesdayThursdayFriday
Child 2
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Sessions ($150 for the week, $50 per dayn)
Full WeekMondayTuesdayWednesdayThursdayFriday
If you have additional children please contact us.
2. Parent information
Phone Number*
Area CodePhone Number

Address*

Payment

Credit Card

Agreement*
I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Chabad permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.
General comments
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1. Child/ren’s Information