Winter Camp!

Parent Name

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Child #1 Name

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Days Attendingif your child will be attending the entire week please only choose the LAST option

Comments - Please list any Allergies or Services Child Receives

Child #2 Name

First NameLast Name

Birth Date

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School

Grade

Days Attendingif your child will be attending the entire week please only choose the LAST option

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

Online Registration is now CLOSED! Please Text Hadassah 516-458-3694about availability

Parent Information

Child #1 Information

Child #2 Information