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Camp Gan Chabad Registration Form

Camp Gan Chabad Registration Form

Registration Form - Summer  Camp 5777/2017
For ages 2 to 4  

Please fill out the form below.

Application forms must be submitted with a non-refundable registration fee of $50.  

Note: Please use a separate form for each child. 

Child/Parent Information
Child's First Name  
Child's Last Name
City,State, Zip:      
Date of Birth: //
Mother Name:
Mother Cell:
Mother Email:
Father Name:
Father Cell:
Father Email:
Emergency Contact, Name and Number  
Pediatrician, Name and Number  
Additional Information about your Child
If your child naps, please select whether you will pick up at 1:00 or your child will be napping in camp. 
Napping Child   

Which weeks, if weekly
Non-refundable Registration Fee: $50:
Please enter your card information below
Card Type:
Card Number:
Exp. Date:


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