CGI Summer Camp - Chabad of North Orlando

Sponsor a Child HERE!
Parents Information
Parent 1 Name:*
First Name Last Name
E-mail:*
Phone Number:*
Parent 2 Name:
First Name Last Name
E-mail:
Phone Number:

Address:*

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

How many children are you registering for CGI Summer Camp?*
Child 1
Full Name:*
First Name Last Name
Age:*
Grade just completed:*
T-Shirt Size*
Please select:*

Week 1 June 29-July 3 $350Week 2 July 6-10 $350Week 3 July 13-17 $350
Please select: AM Care is 8:30-9:30 - PM Care is 3:30-4:30

Week 1: AM care - $40Week 1: PM care - $40Week 2: AM care - $40Week 2: PM care - $40Week 3: AM care - $40Week 3: PM care - $40
Does this student have any allergies?*

YesNo
If yes, please list them:*
Please specify medical conditions or behavioral diagnosis?*

YesNo
If yes, please explain:*
Child 2
Full Name:*
First Name Last Name
Age:*
Grade just completed:
T-Shirt Size*
Please select:

Week 1 June 29-July 3 $325 Early BirdWeek 2 July 6-10 $325 Early BirdWeek 3 July 13-17 $325 Early Bird
Please select: AM Care is 8:30-9:30 - PM Care is 3:30-4:30

Week 1: AM care - $40Week 1: PM care - $40Week 2: AM care - $40Week 2: PM care - $40Week 3: AM care - $40Week 3: PM care - $40
Does this student have any allergies?*

YesNo
If yes, please list them:*
Please specify medical conditions or behavioral diagnosis?*

YesNo
If yes, please explain:*
Child 3
Full Name:*
First Name Last Name
Age:*
Grade just completed:*
T-Shirt Size*
Please select:*

Week 1 June 29-July 3 $325 Early BirdWeek 2 July 6-10 $325 Early BirdWeek 3 July 13-17 $325 Early Bird
Please select: AM Care is 8:30-9:30 - PM Care is 3:30-4:30

Week 1: AM care - $40Week 1: PM care - $40Week 2: AM care - $40Week 2: PM care - $40Week 3: AM care - $40Week 3: PM care - $40
Does this student have any allergies?*

YesNo
If yes, please list them:*
Please specify medical conditions or behavioral diagnosis?*

YesNo
If yes, please explain:*
Sponsor a Child at CGI Summer Camp!

I Would like to Sponsor a Child's CGI Summer Camp Experience - $350
Emergency Contact Information
Emergency Contact 1 Full Name:*
First Name Last Name
Emergency Contact 1 Phone Number:*
Emergency Contact 2 Full Name:*
First Name Last Name
Emergency Contact 2 Phone Number*
Doctor's Name:*

Doctor's Address:

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

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Chabad Hebrew School 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, the Chabad Hebrew School 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 school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in the Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
*

I hereby give permission for my child to attend all field trips and outings sponsored by CGI.I hereby give permission for my child to be photographed. Photos may be used for promotional purposes for Chabad Lubavitch of North Orlando.
Total:

$0.00

I would like to pay today:Full amount$50.00 minimum$

Payment:*

Credit Card Apply for full or partial scholarship using the above information

Postal / Zip Code

Country

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Should be Empty:

Parents Information

Child 1

Child 2

Child 3

Emergency Contact Information