* State--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* How many children are you registering for Winter 2023?Please Choose 1 2 3
Mother/Guardian #1 Information
* Is mother/guardian #1 Jewish?Please Select One Yes No
Father/Guardian #2 Information
Is father/guardian #2 Jewish? Yes No
*Family Information
*We ask these questions in order to better understand and relate to each child.
* Any religious conversions or adoptions in the immediate family?Please Select One No
* Current GradePlease Select One Pre-K (4 y.o.) Kindergarten 1st 2nd 3rd 4th 5th 6th 7th
Camper 1 will attend:
Please select EITHER the entire winter camp week OR individual days. To avoid overpayment, please do not make selections that overlap.
Current Grade Pre-K (4 y.o.) Kindergarten 1st 2nd 3rd 4th 5th 6th 7th
Camper 2 will attend:
Please select EITHER the entire winter camp week OR individual days. To avoid overpayment, please do not make selections that overlap.
Current Grade Pre-K (4 y.o.) Kindergarten 1st 2nd 3rd 4th 5th 6th 7th
Camper 3 will attend:
Please select EITHER the entire winter camp week OR individual days. To avoid overpayment, please do not make selections that overlap.
Permission, Release & Waiver of Liability:
By completing this enrollment form and entering my digital signature below, I as the parent or legal guardian of the above child(ren) hereby release Chabad of Lakeview from any and all liability arising from claims for injuries or damages that either individually or on behalf of my child might occur during participation in Camp Gan Israel activites. I authorize any adult acting on behalf of Chabad of Lakeview's Camp Gan Israel program to treat, hospitalize, or secure treatment for my child. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Camp Gan Israel personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all camp activities and field trips. I understand that my child may be photographed while participating in Camp Gan Israel activities and that these pictures may be used for marketing purposes. By electronically signing my name below, I accept these terms and conditions.