Camp Chabad Summer Camp Pre-registration form

General Information

Child's First Name *

Child's Last Name *

Date of Birth *

Age in June 2024 *

Gender *

Entering Grade (fall 2024) *

School attending *

Father's name *

Mother's name *

Home Phone *

Email *

Home Address *

City *

State *

Zip *

I understand that by pre-registering before February 1, 2024 I can receive the early bird rate of $299 a week (regular rate $320) for 2024.

Every family you recommend that enrolls, gives you a $50 credit! please send information about Camp Chabad 2024 to these families: Name/Address

A Non-refundable deposit of $200 per child is required

Payment information

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV *

Billing Street Address *

City *

State *

Zip Code *