Child's details

Child first name

Last name


Male / Female


Grade in 2020



Medical Information or allergies

Does your child carry an Epipen

Child's mobile if applicable 

Child's Hebrew name

Parents details

Mothers name

Mothers Mobile

Mothers email

Mothers home phone

Fathers name

Fathers Mobile

Fathers email

Fathers home phone

Child's primary address

Is the natural mother of the child Jewish

Are there any conversions in the family, if yes please provide details.

Emergency details

Emergency contact name

Relationship to child

Emergency mobile

Emergency home phone


Is there anything you would like us to know about or be aware of?


In the event camp needs to contact you, please advise us which Chabad center you would like to be in touch with you. If you do not have a particular one, please advise how you became aware of this camp and we will match you up the correct center. Thank you.

Chabad Center


Name of friend who refered you to this camp


I hereby authorise Chabad leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child may be participate in activities within and outside the Chabad grounds. I authorise my child to participate in these activities. I hereby authorise Chabad to photograph my child and to use the photographs at their discretion.

Name of Parent or Guardian

Register and pay

To complete the registration process you will be re-directed to a payment page after clicking below. Registration are only confirmed upon payment. 

"Please note the nominated Credit Card below will be charged prior to camp. If at any stage due to Covid restrictions the camp cannot go ahead you will receive a full refund immediately. "

CTeens is a joint project of Chabad Melbourne