Download a Parents' Handbook\

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. We need you to fill out a health form and fax it to 760-295-0909 or bring it to the Chabad Center. If you have any questions, feel free to contact our Camp Director, Mrs, Nechama Greenberg, who will be happy to discuss your child with you! 760-806-7765 or click to email.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
  First

Middle

Last  
Address
  Street
City State
Zip
Date of Birth
   
Contact Info
  Phone
Email
 
Schools
  School
Hebrew School Entering Grade:
Child's Mother
  Mother's Name
Hebrew Name Work Phone Cell
Child's Father
  Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
  Name
Phone
Relationship
 
Pediatrician
  Name
Phone    
             
Select Child's Age Group
Ages 5-7
Ages 8-10
   
  T-Shirt Size      
Please indicate number of sessions your child will attend camp:
Additional Child: 5% off for multiple children in the same family.
     
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by:Visa Master Card AmEx Check
  Name on Card Amount
  Credit Card Number Expiration Date
CVV Security Code
I have read the application form click here to read the parental consent and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
  Please print the health form and send it to the camp office.
  Date of Application:
Comments:

Scholarships

Contribute to the Fund:

PLEASE COUNT ME IN TO BRING A SMILE TO A CHILD'S FACE.

Yes! I would like to support the Scholarship Fund.
I would like to contribute:

 
 
1 week:
$180
Other:
My Personal Information:

Name:

Address:

Email:

Phone:

Please contact me to discuss this contribution
Payment Information:

Payment type

Visa Master Card AMEX    

Credit Card Info

Number
Expiration Date CVV Security Code
   
  If billing address is different than above please add below.  
Comments: