Gan Izzy Day Camp Booking Form Summer 2025

A joint project of Chabad Youth NSW & Dover Heights Shule

13-17 January 2025 | Boys and Girls Year K-6

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, (not retained from winter camp 2024) which is the only shirt allowed, and additional shirts can be purchased for $10 each.*

Yes

I have signed the Cable Aqua Waiver for my child attending Boys (13th Jan) and Girls (14th Jan) *

Yes - https://waiver.roller.app/cableswakepark/homeN/A

Throughout the camp, we will provide a nutritious lunch along with healthy snacks and drinks to keep our campers energized and hydrated.

Payment Options and Details

Cost Structure: The fee per child is $299 for the entire week or $75 per day.
Sibling Discount: A 5% discount is available for siblings, applicable after the first child is enrolled at full price.
Payment Policy: Full payment is required prior to the start of camp to secure your child’s place.
Cancellation and Absence Fee: A fee of $100 will be charged for any cancellations or absences to cover pre-arranged resources and staffing.

Please ensure timely payment to confirm your child’s participation.

Please calculate the total owing for camp. $75 per day or $299 per week per person. Early Bird Rate of 5% off total is applicable until 23 December 2024*

$ 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 Elimelech on 0433 549 190 or Avremi on 0404 032 166

Gan Izzy Day Camp Booking Form Summer 2025

Gan Izzy Day Camp Booking Form 2025

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