Camp Registration

SUMMER CAMP REGISTRATION 2019
Thank you for expressing interest in our summer camp!
Below are the Dates and Divisions for Summer Camp 2019 with Aventura Chabad:
DATES:
June 17- August 2, 2019
(Full camp experience available for 7 weeks)
1 ^st Session: June 17 - July 12
2^nd Session: July 15 – August 2
(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 6
WEEKLY - MINI & GAN: ($300 per child)
Week 1Week 2Week 3Week 4Week 5Week 6
*
I have emailed medical forms to: info@chabadfl.orgAll vaccines are up to date
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 6
WEEKLY - MINI & GAN: ($300 per child)
Week 1Week 2Week 3Week 4Week 5Week 6
I have emailed medical forms to: info@chabadfl.orgAll vaccines are up to date
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
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Pediatrician & Insurance
First NameLast Name
Phone Number
Area CodePhone Number
Insurance
Policy #
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:
Agreement*
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.
Should be Empty:

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SUMMER CAMP REGISTRATION 2019

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information