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Chabad of the Five Towns

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Winter Camp!

Online Registration is now CLOSED! Please Text Hadassah 516-458-3694about availability
Parent Information
Parent Name
First NameLast Name
Cell Phone Number
Area CodePhone Number
E-mail
I would like to receive news and updates by email
Child #1 Information
Child #1 Name
First NameLast Name
Birth Date
MonthDayYear
School
Grade
Days Attendingif your child will be attending the entire week please only choose the LAST option
Tuesday - Bounce SyossetWednesday - LEGO LandThursday - K & 1st - Long Island Gymnastics l 2nd - 8th Snow TubingFriday - BowlingTuesday - Friday
Comments - Please list any Allergies or Services Child Receives
Child #2 Information
Child #2 Name
First NameLast Name
Birth Date
MonthDayYear
School
Grade
Days Attendingif your child will be attending the entire week please only choose the LAST option
TuesdayWednesdayThursday - K & 1st - Long Island Gymnastics l 2nd - 8th Snow TubingFridayTuesday - 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
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Credit Card I will contact Hadassah regarding payment ( Cash / Check) - 516-458-3694

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$0.00
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