Presidents Week Camp - ChabadGN.com

Campers Form
Counselors click HERE to register
Winter 2023 Dates: Wednesday, February 22 - Thursday February 23

Ages: 6 and up
$80/day or $150/both days - Lunch and snacks included
Child 1
Full Name*

First Name Last Name
Birth Date*

Month Day Year
School Info*

Grade Entering School Attending
T-Shirt Size*
Dates*

Both days 2/22-2/23 $150 Only Wednesday, 2/22 $80 Only Thursday, 2/23 $80
Child 2
Full Name

First Name Last Name
Birth Date

Month Day Year
School Info

Grade Entering School Attending
T-Shirt Size
Dates

Both days 2/22-2/23 $150 Only Wednesday, 2/22 $80 Only Thursday, 2/23 $80
Child 3
Full Name

First Name Last Name
Birth Date

Month Day Year
School Info

Grade Entering School Attending
T-Shirt Size
Dates

Both days 2/22-2/23 $150 Only Wednesday, 2/22 $80 Only Thursday, 2/23 $80
Parents Information

Address*

Home Number*

Area Code Phone Number
Mother's Info
Name*
Cell Number*

Area Code Phone Number
Email*
Work Number*

Area Code Phone Number
Father's Info
Name*
Cell Number*

Area Code Phone Number
E-mail*
Work Number*

Area Code Phone Number
Emergency Contact Information
Please provide 2 emergency contacts besides parents
Contact 1*

First Name Last Name
Relationship to Child*
Cell Number*

Area Code Phone Number

Address*

Address*

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
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

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Campers Form