The biological parents of these children were born Jewish Select all that apply *

Mother

Father

Other - Contact Me

If someone other than a parent or guardian has permission to pick up your child, please list their name(s) below.

Emergency Contact One

Does your child have allergies, take medication, have a chronic medical condition (asthma, ADHD, seizures, etc.), learning challenges or anything else we may need to know? *

In case of accident or illness it is agreed that if the parent or emergency contact cannot be
reached, Camp Chabad After Shcool has permission to provide medical care. I also authorize
the Chabad staff to administer minor first aid (for cuts, scrapes, etc.) if the need arises.
I give my child permission to participate in all After School activities and trips. In addition,
Camp Chabad After School can use photographs of my child in its public relations programs.

The cost of Camp Chabad After School program is $250 a month per child.

If payment is not made in full, you will receive an invoice and will be contacted by the
Chabad office to make payment arrangements.

Camp Chabad After School

Registration Form

Student 1 Profile

Student 2 Profile

Student 3 Profile

Parent Information

Emergency Contact One

Emergency Contact 2

Health & Terms

Payment Information