Registration - Chabad of Las Cruces

Camper Information
Child 1
First NameLast Name
Birth Date
MonthDayYear
FemaleMale
Child 2
First NameLast Name
Birth Date
MonthDayYear
FemaleMale
Child 3
First NameLast Name
Birth Date
MonthDayYear
FemaleMale
Mother's Name
First NameLast Name
E-mail
Cell Number
Area CodePhone Number
Father's Name
First NameLast Name
E-mail
Cell Number
Area CodePhone Number
T Shirt Size
SmallMediumLarge
Please list any known allergies that your child has:
Please describe any medical conditions or behavioral issues that would be beneficial to know in caring for your child.
Parental Consent
I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation, and to obtain emergency medical care as the situation mandates. I agree that Camp Gan Israel, its administration and staff, will not be liable for any injury or health impairment that may occur. My child has permission to participate in any field trip or activity done with Camp Gan Israel. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.
Early Bird (until May 23rd)Reg Price2 Early Birds2 Reg3 Early Birds3 RegContact me about Scholarships
Total
$0.00

Payment

Credit Card Mail Check

Postal / Zip Code

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