Register Online! | Lubavitch Day Camp

Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

First week: August 1st, 2011, Second week: August 8th, 2011

Note: Please use a separate form for each child.

**Please click here to make your camp payment online**

Camper/Parent Information
Name		First	Hebrew name	Last
Address		Street	City/Town	Postcode
Date of Birth
Contact Info		Phone	Email
School		Name	Entering Year:
Synagogue
Child's Mother		Moms name	Work Phone	Mobile
Child's Father		Dads name	Work Phone	Mobile
Emergency Contact Info		Name	Phone	Relationship
Pediatrician		Name	Phone
Address
Information		Any special information about the applicant that is necessary for us to know (allergies, illnesses, special needs etc.)

Select Child's Age Group
	Ages 3-5			Ages 5-9

Please indicate number of weeks your child will attend camp:

	Other Dates
IMPORTANT
•	All forms must be completed and submitted before your child begins camp.

	I am in agreement with the camp treating minor injuries. All first aid will be given in the best interests and well being of the child, this may require the use of plasters for cuts or grazes or, in the event of an insect sting, soothing ointment.

	Date of Application: