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Overnight Camp 5777

Overnight Camp 5777

Camp Registration, Gan Yisrael GIRLS Overnight Camp

Camp dates:
28th December 2016 - 8th January 2017


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

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 2017*
     

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 2017*      
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 2017*      

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 camp.

The cost for camp is R5000 per child. (Camp can be paid off over 6 or 12 months if needed)

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

 
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 YOUTH 
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 Youth
Cash - Please contact the office if you would like to pay cash
   
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 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 Ysrael 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.

 

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