Camp Registration

Child's Name*

First NameLast Name

Gender*

Birth Date*

MonthDayYear

School*

Grade*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area CodePhone Number

Full Name*

First NameLast Name

Hebrew Name*

Cell Number*

Area CodePhone Number

E-mail*

Mother is:*

Full Name*

First NameLast Name

Hebrew Name*

E-mail*

Cell Number*

Area CodePhone Number

Father is:*

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

*

3-5 years old6-8 years old9-11 years old

Please check all that apply*

All forms must be completed and submitted before your child begins camp.

Cost per week is: $125
Lunch can be provided for an additional $25 per week.

All trips and activities are included in camp tuition.

Scholarships are available. No child will be turned away due to lack of funds. To apply for a scholarship, please contact us at: Rabbi@ChabadOfWilmington.org

Full session w/o lunch

$500

Full session with lunch

$600

Weekly selection w/o lunch

$125$250$375

Weekly selection with lunch

$150$300$450

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

I have read the camp brochure and application form and agree to the terms stated.

I give my child permission to attend all trips, and receive medical care in the case of emergency.

Electronic Signature*

Camp Registration

Child Information:

Mother Information:

Father Information:

Emergency Contact:

Physician Information:

Child Age Group:

Sessions - Summer 5778/2018