Chabad Camp Catan

Chabad Camp Catan promises a real adventure in a fun and nurturing space for tots to thrive socially, emotionally and spiritually.

Chabad Camp Catan caters to children ages 2-4 from diverse Jewish backgrounds and affiliations through a stimulating camp experience.

Camp runs from 9:30am-3:00pm, Monday through Friday from July 8th to August 16th 2024.
Where did you hear about us?
1. Child’s Information
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Gender*
Age on July 1*
Sessions ($185 per session)*

Week 1 - July 8-12Week 2 - July 15-19Week 3 - July 22-26Week 4 - July 29-August 2Week 5 - August 5-9Week 6 - August 12-16 (No camp on the 13th)
Medical Information:
Pediatrician
First Name Last Name
Phone Number

Area Code Phone Number
My child is permitted to be given Children's Tylenol, Motrin or similar should the need arise

YesNo
Is your child allergic to any medications? If yes, please explain
Is your child allergic to any foods? If yes, please explain*
Does your child have a medical, developmental or emotional condition that camp should be aware of? If yes, please explain
Are there any social or other challenges we should be aware of?
2. Parents Information
Mothers Info:
Full Name*
Phone Number*

Area Code Phone Number

Address*

E-mail* Primary email
Religion*

Jewish by birthJewish by conversionNot Jewish
Fathers Info:
Full Name*
Phone Number*

Area Code Phone Number
E-mail* Primary email
Religion*

Jewish by birthJewish by conversionNot Jewish
Child may be picked up from camp by:*
Name and Relationship
I would like to receive news and updates by email
3. Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
I hereby give consent to the administration of Chabad Camp Catan to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Chabad Camp Catan will undertake such a decision.
4. Payment Information
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Paypal I will contact Raizy at 561.412.8288 for a payment plan

Postal / Zip Code

Country

General comments
5. Terms and Conditions
- PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Chabad Camp Catan (CCC) unless I advise you otherwise in writing.
- IMAGES, ETC.: Permission is hereby given to use in promoting the Camp and in other ventures directly relating to the Camp (i) digital, photographic and video images or likenesses of camper; audio of camper; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by camper or originating from Camp or from a Camp-related activity.
- INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad Camp Catan (CCC) and its officers, servants or assignees from any liability concerning our child’s involvement in CCC and further agree that the use of any premises during the CCC camp day is made at the risk of the registrant.
- I have read and agree to all of the terms and conditions in this Application Form.
Signature of Parent or Guardian
Date & Time

Month Day Year
at Hour Minutes
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Educate Your Child... Educate a Generation

1. Child’s Information