Guardian Information
First Name
Last Name
Home Address
Zip
Phone
Email
Camper Profile (For more then one, please fill an additional form)
Camper First Name
Camper Last Name
Age
Date of Birth
Is the camper's mother Jewish?
T-Shirt Size
Current School
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Tuition (Includes daily hot lunch and Camp T-shirt)
A $100 security fee per family is due on first day of camp. When would you like to pay it?
Payment Method
Credit Card Information
Type
Visa
MC
Amex
Discover
Number
Expiration
Code
Use contact info above
Name
Address
Zip
Confirm and sign
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Woodland Hills Camp to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Woodland Hills Camp personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all camp activities, join in classes and trips on and beyond camp properties and allow my child to be photographed while participating in Chabad Woodland Hills activities and that these pictures may be used for marketing purposes.
Submit
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