Camp Registration - Aventura Chabad

Thank you for expressing interest in our summer camp!
Below are the Dates and Divisions for Summer Camp 2022 with Aventura Chabad:
DATES:
June 13-July 29
(Full camp experience available for 7 weeks)
1 ^st Session: June 13-July 8
2^nd Session: July 11-July 29
(First session runs for 4 weeks, Second session runs for 3 weeks)
1. Child/ren’s Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
DIVISIONS:*
TINY TOTS (2 Years)MINI GAN IZZY (3 - 4 Years)GAN IZZY (5 - 9 Years)
T-SHIRT FEE:4 T-Shirts per child
$40
T-SHIRT SIZE:
XS (4-5)S (6-7)M (8-10)L (12-16)
ENTIRE SUMMER:
TINY TOTS: ($1,200)MINI & GAN: ($1,400)
SESSION - TINY TOTS:
Session 1 ($800)Session 2 ($600)
SESSION - MINI & GAN:
Session 1 ($1,000)Session 2 ($750)
WEEKLY - TINY TOTS: ($250 per child)
Week 1Week 2Week 3Week 4Week 5Week 6Week 7
WEEKLY - MINI & GAN: ($300 per child)
Week 1Week 2Week 3Week 4Week 5Week 6Week 7
*
I have emailed medical forms to: [email protected]All vaccines are up to date
Allergies/Special Health Considerations
Signature:*
Child 2
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
DIVISIONS:
TINY TOTS (2 Years)MINI GAN IZZY (3 - 4 Years)GAN IZZY (5 - 9 Years)
T-SHIRT FEE:4 T-Shirts per child
$40
T-SHIRT SIZE:
XS (4-5)S (6-7)M (8-10)L (12-16)
ENTIRE SUMMER:
TINY TOTS: ($1,200 per child)MINI & GAN: ($1,400 per child)
SESSION - TINY TOTS:
Session 1 ($800)Session 2 ($600)
SESSION - MINI & GAN:
Session 1 ($1,000)Session 2 ($750)
WEEKLY - TINY TOTS: ($250 per child)
Week 1Week 2Week 3Week 4Week 5Week 6Week 7
WEEKLY - MINI & GAN: ($300 per child)
Week 1Week 2Week 3Week 4Week 5Week 6Week 7
I have emailed medical forms to: [email protected]All vaccines are up to date
Allergies/Special Health Considerations
Signature:
If you have additional children please contact us.
2. Parent information

Address:*

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

Mother's info
First NameLast Name
Work Phone
Area CodePhone Number
E-mailPrimary email
Cell Phone*
Area CodePhone Number
Father's info
First NameLast Name
Work Phone
Area CodePhone Number
E-mail
Cell Phone*
Area CodePhone Number
3. Emergency Information
Primary Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship to Child*
Secondary Emergency Contact
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to Child
Medical Information
Hospital/Clinic Preference*
Physician's Name*
First NameLast Name
Phone Number*
Area CodePhone Number
Insurance
Policy #
Authorization:*
I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.I give permission for my child to go on field trips. I release Aventura Chabad and individuals from liability in case of accident during activities related to Aventura Chabad, as long as normal safety procedures have been taken.By entering your first and last name below, you electronically acknowledge having read and understood this Agreement and agree to the terms and conditions herein.Your first and last name below represents your agreement to all the terms and conditions written above and will serve as your consent to all the terms and conditions written above.
Signature:*
First NameLast Name
Date:*
4. Payment Information
Non-refundable registration fee
$100
A $100 non-refundable registration fee applies as part of this registration.
Total Amount:
$100.00

Payment:*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Payment Options:
Full Payment2 Payments3 Payments4 Payments
Please indicate any specific information that you think is necessary here:
Terms of Agreement
(PLEASE READ CAREFULLY-NO EXCEPTIONS)
I understand:*
1. Payment in full is due with application, including all head checks or credit cards.2. Payment is Non-Refundable, for any reason, even if your child does not attend the program.3. Withdrawal of enrollment privileges, for any reason, does not relieve the Undersigned of the responsibility for the payment of the entire financial obligations for the program you enrolled your child in.4. By entering your first and last name below, you electronically acknowledge having read and understood this Agreement and agree to the terms and conditions herein.5. Your first and last name below represents your agreement to all the terms and conditions written above and will serve as your consent to all of the terms and conditions written above.
Signature:*
First NameLast Name
Date:*
Should be Empty:

1. Child/ren’s Information

2. Parent information

3. Emergency Information

Medical Information

4. Payment Information

Terms of Agreement