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Register

Register

Download a Parents' Handbook\

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. We need you to fill out a health form and fax it to 760-295-0909 or bring it to the Chabad Center. If you have any questions, feel free to contact our Camp Director, Mrs, Nechama Greenberg, who will be happy to discuss your child with you! 760-806-7765 or click to email.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
First

Middle

Last
Address
Street
City State
Zip
Date of Birth
Contact Info
Phone
Email
Schools
School
Hebrew School Entering Grade:
Child's Mother
Mother's Name
Hebrew Name Work Phone Cell
Child's Father
Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
Name
Phone
Relationship
Pediatrician
Name
Phone
Select Child's Age Group
Ages 4-6
Ages 7-10
Ages 11-14
T-Shirt Size
Please indicate number of sessions your child will attend camp:
Additional Child: 5% off for multiple children in the same family.
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by:Visa Master Card AmEx Check
Name on Card Amount
Credit Card Number Expiration Date
CVV Security Code
I have read the application form click here to read the parental consent and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
Please print the health form and send it to the camp office.
Date of Application:
Comments:

Scholarships

Contribute to the Fund:

PLEASE COUNT ME IN TO BRING A SMILE TO A CHILD'S FACE.

Yes! I would like to support the Scholarship Fund.
I would like to contribute:

Complete Summer:
$350
1 week:
$180
Other:
My Personal Information:

Name:

Address:

Email:

Phone:

Please contact me to discuss this contribution
Payment Information:

Payment type

Visa Master Card AMEX

Credit Card Info

Number
Expiration Date CVV Security Code
If billing address is different than above please add below.
Comments:

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