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Register Now! winter camp

Register Now! winter camp

Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Name
Child 2

Camper/Parent Information
Name
Child 1
  First  Middle  Last   


Name
Child 2
 

  First  Middle  Last   
  My updated information is at Chabad (skip to next Section). Or:
 
 
Address
  Street
City Province 
Postal Code 
Date of Birth
   
Contact Info
  Phone
Email
 
Schools
  School
Hebrew School Entering Grade:
Child's Mother
  Mother's Name
Hebrew Name Work Phone Cell
Child's Father
  Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
  Name
Phone Relationship  
Pediatrician
  Name
Phone    

Email

     
           
Select Child's Age Group
Ages 5-7
Ages 8-11  
 
       
 
 
Please indicate which session/s your child will attend camp:
   
   

 Full Prorgam Monday, December 24 - Friday, December 28    

 For the following days: 

                          FOR RATES CLICK HERE

IMPORTANT
All forms must be completed and submitted before your child begins camp.

I will be paying by:
Cheque - mail a cheque to:
Chabad of Vancouver Island
#322 - 1095 Meckenzie Ave.
Victoria, BC V8P 2L5

Credit card - submit a payment here. (there will be an extra 3% charge for credit card use).

I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.