CAMP CHABAD 2022 Camp Register FormPlease enable JavaScript in your browser to complete this form. - Step 1 of 6Registration Form & Fees 1. Child's Information Your Child *FirstMiddleLastBirth Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's currently class *ToddlersPre-NurseryNurseryPre-KHalf Day or Full Day *Half dayFull dayNext 2. Parent Information Parent 1 *FirstLastMobile Phone Number *Work PhoneAddress *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmail *Primary EmailParent 2FirstLastMobile Phone NumberParent 2 EmailNext 3. Emergency Information Emergency Contact (not parent) *FirstLastPhone Number *Relationship *Next 4. Payment Information Tuition includes daily hot lunches, morning and afternoon snacks Summer group placement may not necessarily be the same as that of the school year All groups are dismissed 1:00 pm on Fridays There is no Early Drop-Off or Late Pickup in the summer There is no camp Tuesday, July 4, in observance of Independence Day Your child needs to have a current medical form and be fully immunized in order to attend Camp Chabad. (The office will let you know if you need an updated form for the summer.) Your spot in Camp Chabad is confirmed *only* when you receive an email confirmation that we have received your payment online or the post-dated checks (which can be dropped off at the Chabad ELC office.) Refund Policy: Withdrawal before 6/1/23: Complete refund, less deposit. Withdrawal before 6/26/23: 50% refund. Withdrawal after 6/26/23: No refund. There are no refunds, credits or make-up days due to illnesses, holidays or family vacations. - If you do not receive an email confirmation within a week, please contact the office at camp@chabadelc.com Next Non-refundable deposit due with your registration today (this will be credited towards your tuition) *$200Balance after the deposit: *Pay the full amount today (1,295.00)Send the balance in two post-dated checks dated 04/01/2023 and 05/01/2023 for the remaining balanceBalance after the deposit: *Pay the full amount today (1,525.00)Send the balance in two post-dated checks dated 04/01/2023 and 05/01/2023 for the remaining balanceBalance after the deposit: *Pay the full amount today (1,525.00)Send the balance in two post-dated checks dated 04/01/2023 and 05/01/2023 for the remaining balanceTotal$0.00Next 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 Camp Chabad permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.Submit