New JLI course Survival of a Nation starts 10 May
Printed from ChabadSouthAfrica.org

Travel Camp

Travel Camp

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Family Information
Family Name Fathers Name Mothers Name
Fathers Cell Mother Cell     Home Phone
Street Address State ZIP
Mothers Email Fathers Email    
 
Full Name Hebrew Name   Called By
Age DOB
  Grade
Nationality Passport country of issue   Passport Number

 

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

Does your child have a behavior plan in school? No Yes. If yes, please explain:
Please list any allergies, health problems, medications, or health information the camp needs to know:
 
I confirm my daughter has Health Insurance that is valid in South Africa
 
School Information
Name of School your child attends  
Principal's Name  
 School Tel #  
Principal's Email   
Reference Name  
Reference Email  
I hereby grant permission  to contact my child's school to discuss my child's behavioral needs.

 

Payment Info- I will pay by:
The cost for camp is $2600 + Airfare
Credit Card
Card Number
Expiry Date
CCV (3 digits on back)

Cash
Notes

 

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 SA Travel 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 Chabad Youth to authorize any emergency action necessary to insure the safety of my child.

I understand that by participating in any SA Travel Camp 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, 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, 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 the camp

I understand that all applications are non refundable.

I understand that by enrolling in SA Travel Camp I am agreeing to abide by all its policies.

 

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