Special Gan Izzy Day Camp Dec 2025

30 Dec 2025 - 01/01/2026 | Boys and Girls Year K-6

Program 10:00am - 2:00 pm

Child 1 Full Name*

First Name Last Name

Child 1 Birth Date*

Month Day Year

Child 1 Gender*

Child 1 Days Attending:*

TuesdayWednesdayThursday

Child 2 Full Name

First Name Last Name

Child 2 Birth Date

Month Day Year

Child 2 Gender

Child 2 Days Attending:

TuesdayWednesdayThursday

Child 3 Full Name

First Name Last Name

Child 3 Birth Date

Month Day Year

Child 3 Gender

Child 3 Days Attending:

TuesdayWednesdayThursday

Child 4 Full Name

First Name Last Name

Child 4 Birth Date

Month Day Year

Child 4 Gender

Child 4 Days Attending:

TuesdayWednesdayThursday

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*

We will provide snacks and drinks to keep our campers energized and hydrated. Please provide Kosher lunch for your child(ren)

Payment Information

$50 per day
NSW Active Kids Vouchers will be accepted
Payment Policy: Full payment is required prior to the start of camp to secure your child’s place.
Cancellation and Absence Fee: any cancellations less than 24 hours in advance will not be refunded

Please calculate the total amount owing for camp. The rates are $50 per day. If you are using a Creative Kids Voucher, $50 per child can be deducted—subject to the voucher being valid and successfully processed.*

$ 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

By enrolling my child in camp, I agree to and accept all Chabad Youth NSW policies on their behalf, including the behaviour policy, available at cyn.org.au/cgipolicies.*

I agree

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

I hereby acknowledge and accept that Sydney Talmudical College Association, Lubavitch Jewish Centre, Chabad Youth NSW, Dover Heights Shule, and Kesser Torah College, including their employees and agents, bear no responsibility for any harm or injury that may befall my child during their participation in camp.

In the event that my child becomes ill or injured during the course of camp, I authorise the above-mentioned organisations to take all necessary steps to ensure my child receives appropriate medical attention. I accept full responsibility for any medical costs incurred as a result.

I understand that my child will be participating in activities both on and off the camp premises, and I give permission for my child to take part in all such activities. I also authorise the camp to sign activity and excursion waivers on my behalf, where required.

Furthermore, I agree to indemnify Sydney Talmudical College Association, Lubavitch Jewish Centre, Chabad Youth NSW, Dover Heights Shule, Kesser Torah College, and their employees and agents, against any demands, claims, actions, or legal proceedings brought by any party, arising from or related to any act or omission by my child during the camp.

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

Special Gan Izzy Day Camp Dec 2025

Special Gan Izzy Day Camp Dec 2025

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