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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
*
M
F
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
*
Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (mm/yy)
*
CVV
*
Billing Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*