Child first name
Male / Female
Medical Information or allergies
Does your child carry an Epipen
Child's mobile if applicable
Child's Hebrew name
Ski or Snow Board
Mothers home phone
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 contact name
Relationship to child
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.
Name of friend who refered you to this camp
Shabbaton Fee: No Charge
DECLARATION OF PARENT / GUARDIAN
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
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