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Register CGI Dec 15

Register CGI Dec 15

Camp Registration, December 2015 - 5776

REGISTRATION IS CLOSED

Camp dates:
Week 1: 7th - 11th December
Week 2: 14th - 18th December


Please Note: We will not reserve a space in camp for your child without payment.

Family Information
Family Name Fathers Name Heb Name
Mothers Name Heb Name Home Phone
Fathers Cell # Fathers Work # Fathers Email
Mothers Cell # Mothers Work # Mothers Email
Marital Status Married Divorced Separated Widowed Other
Camper Information
Child #1
Full Name Hebrew Name Called By
Gender Age Birthdate
School Grade going into in 2016*
Kiddie Camp only: Teachers name
Camp t-shirts are available for R15 each, Please select your child's size

Main Camp (5-12 yrs old)
Week 1 (7th - 11th)
Week 2 (14th - 18th)

Both Weeks

Kiddie Camp (3-4 yrs old)
Week 1 (7th - 11th)

Week 2 (14th - 18th)
Both Weeks


Does your child require extra help in school? No Yes. If yes, please explain:

Please list any allergies, health problems, medications, or health information the camp needs to know:
Child #2
Full Name Hebrew name Called By
Gender Age Birthdate
School Grade going into in 2016* Kiddie Camp only: Teachers name

Camp t-shirts are available for R15 each, Please select your child's size


Main Camp (5-12 yrs old)
Week 1 (7th - 11th)

Week 2 (14th - 18th)

Both Weeks

Kiddie Camp (3-4 yrs old)Week 1 (7th - 11th)

Week 2 (14th - 18th)

Both Weeks

Does your child require extra help in school? No Yes. If yes, please explain:
Please list any allergies, health problems, medications, or health information the camp needs to know
Child #3
Full Name Hebrew name Called By
Gender Age Birthdate
School Grade going into in 2016* Kiddie Camp only: Teachers name
Camp t-shirts are available for R15 each, Please select your child's size
Main Camp (5-12 yrs old)
Week 1 (7th - 11th)
Week 2 (14th - 18th)
Both Weeks

Kiddie Camp: (3-4 yrs old)
Week 1 (7th - 11th)
Week 2 (14th - 18th)
Both Weeks


Does your child require extra help in school? No Yes. If yes, please explain:
Please list any allergies,health problems, medications, or health information the camp needs to know
Child #4
Full Name Hebrew name Called By
Gender Age Birthdate
School Grade going into in 2016* Kiddie Camp only: Teachers name
Camp t-shirts are available for R15 each, Please select your child's size
Main Camp: (5 - 12 yrs old)
Week 1 (7th - 11th)
Week 2 (14th - 18th)
Both Weeks
Kiddie Camp: (3-4 yrs old)
Week 1 (7th - 11th)
Week 2 (14th - 18th)
Both Weeks

Does your child require extra help in school? No Yes. If yes, please explain:
Please list any allergies, health problems, medications, or health information the camp needs to know
Emergency Contact
Name Relationship Phone

I hereby grant permission for Camp Gan Yisrael to contact my child's school to discuss my child's behavioral needs.

Yes I would like to sponsor children to attend weeks of camp.

The cost for camp is R650 per week per child or R1050 for both weeks per child.

The cost per t-shirt is R15.

Please Note: We will not reserve a space in camp for your child without payment.

Payment Info - I will pay by:
EFT
Please send proof of payment to camp@chabad.org.za
Banking Details: STANDARD BANK ELLIS PARK
Account name: CHABAD HOUSE
Account Number: 201 551 195
Branch code: 004605
Ref: You child's full name
Credit Card
Card Number
Expiry Date
CCV (3 digits on back)
Cheque (Make payable to Chabad House
Cash - can be paid at Chabad House
Notes

For payment plan options please contact Rabbi Pink on 011 440 6600

IMPORTANT

I give my permission to use the photograph of my child as well as myself for promotional purposes.

My child has my permission to participate in Camp Gan Yisrael Day Camp. I understand that this program includes field trips and activities off the premises.

I understand that in case of emergency and I am unable to be contacted, I give permission to Camp Gan Yisrael to authorize any emergency action necessary to insure the safety of my child.

I understand that by participating in any Camp Gan Yisrael activities and use of any recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities to be conducted by the Camp Gan Yisrael, I/ We as an individual or as a parent or guardian of the participants named herein, assume all risk and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless the Camp Gan Yisrael, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at or conducted by Camp Gan Yisrael.

I understand that all applications are non refundable.

I understand that by enrolling in Camp Gan Yisrael I am agreeing to abide by all its policies.