Winter Day Camp - CYNSW 2018.jpg

Gan Izzy Winter Day Camps

16 - 20 July 2018

Program 9:00am - 4:00 pm / Friday end at 2:00pm | Boys and Girls Age 4 - 13




Child 1 Last Name First Name DOB

Child 2 Last Name First Name DOB

Child 3 Last Name First Name DOB

Child 4 Last Name First Name DOB


Days Attending:

Week Boys Mon Tues Wed Thur Fri

Week Girls Mon Tues Wed Thur Fri 


 

Contact Details:

Parent Name*  

Home Phone Number*  Mobile*  Email* 

Home Address*  Suburb*  Post Code* 

Emergency Contact:

Name*  Phone*  Relationship to child* 


Medical information:

Medicare no. expiry date

Private hospital insurance fund and number

Full list of all current medications and dosages

Drug allergies

Any medical conditions (past and current)

Date of latest booster (including ADT, triple antigen, infanrix or CDT vaccines)

Local GP: name, address, office phone and after hours phone/mobile


Other Guests Names (please separate with a comma)

Total Number of days attending

Comment


Camp will provide lunch Snacks and drinks throughout camp.


Payment Options

Costs for all campers is $240 per week OR $50 Per day

To apply for a subsidy through the Gan Yisroel Subsidy fund, please click HERE 

Payment information must be provided before camp, charges will only be made at the end of Camp.

Card type

Card No. Expiry Month Year

Name on the Card

 

For a full list of our Policies and Procedures, please click here  

 

I hereby accept that Sydney Talmudical College Association, Bnei akiva, Lubavitch Jewish Centre, Tzemach Tzedek Community Centre, Chabad Youth NSW or their employees and agents, bear no responsibility for any harm or injury that might befall my child. In the event of my child becoming ill or injured during the course of camp, I authorise the above mentioned entities to take the necessary steps to ensure that my child receives appropriate medical attention, for which I will accept full payment for any costs incurred.

I acknowledge that my child will be participating in camp activities both within and outside the camp venue grounds. I authorise my child to participate in these activities.


I hereby indemnify Sydney Talmudical College Association, Bnei Akiva, Lubavitch Jewish Centre, Tzemach Tzedek Community Centre, Chabad Youth NSW their employees and agents, for any demands, claims, actions or suits made against any of them, by any person, arising from or in relation to any act or omission by my child.

Parent / Guardian Signature*  Date* 

For more information please call 02 8091 7234 or 0433 549 190