Camp Registration form

Rates

Week 1: August 4-7: $275
Week 2: August 10-14: $340
Week 1&2: August 4-7, 10-14: $599

$75 Registration fee per family

5% Sibling Discount

Boys and Girls: Ages 5 - 10

Your bill will be sent to you via email after your child is accepted to camp

How many children will we be signing up today?**

Father's Name*

First Name Last Name

Father's E-mail*

Father's Phone Number*

Mother's Name

First Name Last Name

Mother's E-mail*

Mother's Phone Number*

Address*

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

Other Address (if applicable)

Please briefly explain the reason.

Address

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

Home Phone Number

Is the natural mother of the child Jewish?*

If there have been adoptions or conversions in the family, please explain.

Full Name*

First Name Last Name

Gender*

MaleFemale

Birth Date*

Month Day Year

School Attending*

I'd like to sign my child up for*

Week 1: August 4-7Week 2: August 10-14Week 1&2: August 4-7, 10-14

Full Name*

First Name Last Name

Gender*

MaleFemale

Birth Date*

Month Day Year

School Attending*

I'd like to sign my child up for*

Week 1: August 4-7Week 2: August 10-14Week 1&2: August 4-7, 10-14

Full Name*

First Name Last Name

Gender*

MaleFemale

Birth Date*

Month Day Year

School Attending*

I'd like to sign my child up for*

Week 1: August 4-7Week 2: August 10-14Week 1&2: August 4-7, 10-14

Is your child/ren taking any medications?*

YesNo

Has your child/ren had any major surgeries in the past?*

YesNo

Does your child/ren have any allergies?*

YesNo

If yes, please provide details of any relevant health information for the child or children.

Full Name*

First Name Last Name

Phone Number*

Relation

Full Name

First Name Last Name

Phone Number

Relation

Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Chabad Newmarket Kids Day Camp

Health Guidelines
I agree to follow all camp health policies. I will check my child’s temperature each morning and will not send them to camp if they have a fever, vomiting, diarrhea, or any flu-like symptoms. I will also keep them home if they have recently traveled or been in contact with someone who may be ill.
I understand that campers may be screened daily, including temperature checks, and will be sent home if a fever is detected.

Parental Consent
I give permission for my child to participate in all camp activities.

Payments & Cancellations
All registrations require a payment plan to secure a spot.

No refunds will be given within 5 weeks of the program start date.
No refunds are provided if a camper is unable to attend due to illness.
If the camp must close due to illness, a prorated refund will be issued for unused days to affected families.

Camper Conduct
Camp reserves the right to dismiss any camper whose behavior is disruptive or unsafe. No refunds will be issued in such cases.

Medical Care
In case of emergency, the camp may arrange medical care for my child. Every effort will be made to contact parents/guardians first. Any medical expenses are the responsibility of the parent/guardian.
Parents must inform the camp of any contagious illness.

Photos & Media
I give permission for my child’s photos, videos, and camp-related creations to be used for camp promotions (including social media).

Liability Waiver
I understand that participation in camp activities is at my own risk. I agree not to hold the camp or its staff liable for any injuries or incidents related to camp participation.
I confirm that I am the parent/guardian and that this agreement is legally binding.

Print name here* * I agree to the terms and conditions above

Comments

Parent Information

Child Information

Child #2 Information

Child #3 Information

Health Information

Emergency Contact #1

Emergency Contact #2

Payment

Camp Policies & Parent Agreement