Online Registration is now CLOSED! Please Text Hadassah 516-458-3694about availability Parent Information Parent Name First Name Last Name Cell Phone Number Area Code Phone Number E-mail I would like to receive news and updates by email Child #1 Information Child #1 Name First Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Grade Days Attending if your child will be attending the entire week please only choose the LAST option Tuesday - Bounce Syosset Wednesday - LEGO Land Thursday - K & 1st - Long Island Gymnastics l 2nd - 8th Snow Tubing Friday - Bowling Tuesday - Friday Comments - Please list any Allergies or Services Child Receives Child #2 Information Child #2 Name First Name Last Name Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School Grade Days Attending if your child will be attending the entire week please only choose the LAST option Tuesday Wednesday Thursday - K & 1st - Long Island Gymnastics l 2nd - 8th Snow Tubing Friday Tuesday - Friday Comments - Please list any Allergies or Services Child Receives As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Chabad of the Five Towns to hospitalize or secure treatment for my child/ren, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Winter Camp personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child/ren to participate in all camp activities, join in camp trips on and beyond camp properties and allow my child/ren to be photographed while participating in Chabad Winter Camp activities and that these pictures may be used for marketing purposes. I Accept Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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