Cteen Camp

Boys and Girls Grades 7-10
Camp Hours
9:30 AM - 5:30 PM Monday-Thursday

Summer 2018 Dates:June 24 - August 16

Prices
600 per week (includes lunch and snack).
Early Bird: 550 Per week Lunch Menu (ENDS March 10)
Breakfast, Lunch, & Dinner - is included
Click HERE for more info
Click HERE for last years photos
Click HERE for last years Trip Calendar
TEEN Camp Registration
For full list of trips check HERE
Child 1
Full Name*
First NameLast Name
Birth Date*
MonthDayYear
School Info*
Grade EnteringSchool Attending
T-Shirt Size*
Any Allergies?*
NoYes - list all allergies below
Allergies
Dates Attending Check all that apply (at least 2 weeks)*
Week 1: 6/24 - 6/28Week 2: 7/1 - 7/5Week 3: 7/8 - 7/12Week 4: 7/15 - 7/19Week 5: 7/22 - 7/26Week 6: 7/29 - 8/2Week 7: 8/5 - 8/9Week 8: 8/12 - 8/16
Busing $50/week
YesNo
Weeks need bussing
Dont need bussingWeek 1: 6/24 - 6/28Week 2: 7/1 - 7/5Week 3: 7/8 - 7/12Week 4: 7/15 - 7/19Week 5: 7/22 - 7/26Week 6: 7/29 - 8/2Week 7: 8/5 - 8/9Week 8: 8/12 - 8/16
Child 2
Full Name
First NameLast Name
Birth Date
MonthDayYear
School Info
Grade EnteringSchool Attending
T-Shirt Size
Any Allergies?
NoYes - list all allergies below
Allergies
Dates Attending Check all that apply (at least 2 weeks)
Week 1: 6/24 - 6/28Week 2: 7/1 - 7/5Week 3: 7/8 - 7/12Week 4: 7/15 - 7/19Week 5: 7/22 - 7/26Week 6: 7/29 - 8/2Week 7: 8/5 - 8/9Week 8: 8/12 - 8/16
Busing $50/week
YesNo
Weeks need bussing
Don't need bussingWeek 1: 6/24 - 6/28Week 2: 7/1 - 7/5Week 3: 7/8 - 7/12Week 4: 7/15 - 7/19Week 5: 7/22 - 7/26Week 6: 7/29 - 8/2Week 7: 8/5 - 8/9Week 8: 8/12 - 8/16
Parents Information

Address*

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

Home Number*
Area CodePhone Number
Mother's Info
Name*
Cell Number*
Area CodePhone Number
Email*
Father's Info
Name*
Cell Number*
Area CodePhone Number
E-mail*
Emergency Contact Information
Please provide 2 emergency contacts besides parents
Contact 1*
First NameLast Name
Relationship to Child*
Cell Number*
Area CodePhone Number
E-mail*
Contact 2*
First NameLast Name
Relationship to Child*
Cell Number*
Area CodePhone Number
E-mail*
Total
$1100.00
NO CANCELLATIONS | NO REFUNDS
Terms and Conditions*
I, the undersigned agree, understand and authorize the amount shown above to be charged to my credit card for the items shown on the referenced order. I understand these charges will appear on my credit card statement under my name and I accept full financial responsibility for payment of this order.I agree payments are non-refundable and services / merchandise have been rendered / delivered to my satisfaction.
By entering your email you are accepting the terms above*

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Comments
Your registration will only be confirmed once we get a copy of your child's Medical Form and once payment is settled. Please email the form to Camp@ChabadGN.com
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TEEN Camp Registration