Gan Izzy Day Camp Booking Form 2024

A joint project of Chabad Youth NSW & Dover Heights Shule

15 - 19 July 2024 | Boys and Girls age 4 - 12

Program 9:00am - 4:00 pm / Friday end at 2:00pm

For more information and the parent handbook including trip info, please click here

A minimum of 2 days must be booked to join the camp.

Child 1 Full Name*

First Name Last Name

Child 1 Birth Date*

Month Day Year

Child 1 Gender*

Child 1 Days Attending:*

Child 2 Full Name

First Name Last Name

Child 2 Birth Date

Month Day Year

Child 2 Gender

Child 2 Days Attending:

Child 3 Full Name

First Name Last Name

Child 3 Birth Date

Month Day Year

Child 3 Gender

Child 3 Days Attending:

Child 4 Full Name

First Name Last Name

Child 4 Birth Date

Month Day Year

Child 4 Gender

Child 4 Days Attending:

Parent / Gaurdian Name*

First Name Last Name

E-mail*

I would like to receive news and updates by email

Phone Number*

Area Code Phone Number

Address*

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

Emergency contact*

First Name Last Name

Relationship to child*

Phone Number*

Area Code Phone Number

Medical information:*

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*

I acknowledge that a $10 fee per camper will be charged for a brand new camp t-shirt, which is the only shirt allowed, and additional shirts can be purchased for $10 each.*

Yes

Camp will provide lunch Snacks and drinks throughout camp

Payment Options

Cost per child for is $300 per week or $75 Per day

5% discount for siblings. Discount will apply after first full paying child.

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

Full Payment must be provided before camp.

There will be $100 fee for cancellations and absences.

Please add total owing for camp. $75 per day or $300 per week per person. Early Bird Rate of 5% off total is applicable until 27 June. *

$ AUD

Total

$0.00 AUD

Payment*

Credit Card

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

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

I hereby accept that Sydney Talmudical College Association, Lubavitch Jewish Centre, Chabad Youth NSW, Dover Heights Shule and Kesser Torah College 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, Lubavitch Jewish Centre, Chabad Youth NSW, Dover Heights Shule and Kesser Torah College 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*

First Name Last Name

Date*

Month Day Year

at Hour Minutes

For more information please call 0433 549 190

Gan Izzy Day Camp Booking Form 2024

Gan Izzy Day Camp Booking Form 2024

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