Gan Yisroel Winter Overnight Camp form July 2024

Boys Camp: 16 - 21 July 2024

Age 9 - 16 | Years 4 -11

Location: Crosslands Youth Centre, NSW

Registration closes 9th July at 9am (unless filled sooner)

Early Bird Rate has ended and Subsidy Forms strictly end 9 July 2024 at 9am.

Camper 1 Full Name*

1 First Name 1 Last Name

Camper 1 Camp Attending*

Camper 1 Birth Date*

1 Month 1 Day 1 Year

Camper 1 School Yr*

Camper 2 Full Name

2 First Name 2 Last Name

Camper 2 camp attending

Camper 2 Birth Date

2 Month 2 Day 2 Year

Camper 2 School Yr

Camper 3 Full Name

3 First Name 3 Last Name

Camper 3 camp attending

Camper 3 Birth Date

3 Month 3 Day 3 Year

Camper 3 School Yr

Parent / Guardian Name*

Prefix First Name Last Name

Parent / Guardian Address*

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

E-mail*

I would like to receive news and updates by email

Phone Number*

Area Code Phone Number

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*

Camp will provide Healthy Meals, Snacks and Drinks throughout camp

Payment Options:

The Early Bird Rate cost per child for Overnight camp was $700 (ended 31 May 2024 at 9am)
The Full Rate cost per child for Overnight camp is $850

*All above-listed rates are already subsidised at a rate of 50% by Chabad Youth NSW.

All fees must be paid by 09/07/2024 - if you have only paid the deposit, your card will be charged the remainder

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

Full Payment must be provided before camp.

There will be no refunds for cancellations or absences.

The Early Bird Rate cost per child for Overnight camp is $700 (ended 31 May 2024 at 9am) . The Full Rate cost per child for Overnight camp is $850. A minimum $225 deposit is required at time of registration.*

$850 AUD$225 AUD

Total

$0.00 AUD

Yes, I'd like to donate the cost of processing this transaction by adding 2%

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, Chabad North Shore 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, Chabad North Shore, 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 or email [email protected]

Gan Yisroel Winter Overnight Camp form July 2024

Gan Yisroel Winter Overnight Camp 2024

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