Printed from ChabadHouse.org.au
ב"ה

Enrolment Form

  • If your child has attended Camp Gan Izzy or Chabad Hebrew School since 2019, Click here to use the shorter "returning child" enrolment form. 

    See here for the full list of rates.

    DUE TO THE CURRENT COVID-19 OUTBREAK, A NUMBER OF PRECAUTIONS HAVE BEEN PUT IN PLACE. PLEASE CONTACT US AT [email protected] OR [email protected] FOR MORE INFORMATION.

    THERE HAS BEEN CHANGES TO THE CAPACITY FOR SOME DAYS, THE DAYS YOU CHOOSE MAY NOT BE AVAILABLE. WE WILL CONTACT YOU AFTER ENROLMENT TO CONFIRM DATES.

  • CHILD 1

  • DATES

    Please choose the date/s that you would like your child to attend. 

  • Early Drop-off / Late Pick-up

    Please select below if you would like early drop-off or late pick-up for an additional $5 each per day. 

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to [email protected]au and ensure they bring their medication on each day.

  • ADDITIONAL INFORMATION

  • CHILD 2

  • DATES

    Please choose the date/s that you would like your child to attend. 

  • Early Drop-off / Late Pick-up

    Please select below if you would like early drop-off or late pick-up for an additional $5 each per day. 

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to [email protected] and ensure they bring their medication on each day.

  • ADDITIONAL INFORMATION

  • CHILD 3

  • DATES

    Please choose the date/s that you would like your child to attend.  

  • Early Drop-off / Late Pick-up

    Please select below if you would like early drop-off or late pick-up for an additional $5 each per day. 

  • CHILD INFORMATION 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • AUTHORISATION

  • MEDICAL CONDITION & DIETARY RESTRICTION 

  • If yes, you MUST email a colour copy of your child’s Action Plan to [email protected] and ensure they bring their medication on each day.

  • ADDITIONAL INFORMATION

  • PARENTS/GUARDIAN DETAILS

    PRIMARY PARENT/GUARDIAN

    (This person's details are used to claim government subsidy) 

  • CCS (Child Care Subsidy) Details 
    (this is required to receive government subsidies)

  • SECONDARY PARENT/GUARDIAN 

  • ADDITIONAL/EMERGENCY CONTACTS

    (Minimum 2 required)

    Please enter additional contacts for this enrolment. This may include emergency contacts when you are unavailable to be contacted in the case of an emergency. E.g for medical authorisations, to authorise staff to remove the child form the facility or for any other emergencies. This may also include authorised nominees who may drop off or pick up this child or authorise excursions.

  • ADDITIONAL/EMERGENCY CONTACT  1   

  • ADDITIONAL/EMERGENCY CONTACT 2 

  • MEDICAL CONTACTS 

    Please enter your child's Doctors information. You should enter medical contact here.  

  • IMMUNISATIONS 
    The service needs to sight your child's Immunisation history statement. 

    Please email [email protected] with your child’s Medicare Immunisation form.

  • CHILD CARE SUBSIDY (CCS) ENROLMENT AGREEMENT 

    As a part of your enrolment at our service we require you to confirm acceptance of the following items in order to be eligible to receive Government funding if available. Acceptance of these items as well as some of the other information in the enrolment form can be used as a Complying Written Arrangement. Please read these items and confirm your acceptance of these items, by signing below.

    ·   I confirm that my details in this enrolment form as well as the details of the child I am enrolling are correct.

    ·   I confirm I have agreed to days of care with this service and understand the start and end times of the care provided.

    ·   I confirm that care may be provided on a casual or flexible basis where available at my service(s) at my request.

    ·  I confirm I understand the usual fees associated with the care of my child which may vary from time to time.

    Camp Gan Izzy Enrolment Agreement

    By signing below, I confirm,

    I indemnify Chabad North Shore against responsibility for any accident, loss or injury suffered by my child/ren during the course of the activities.

    I expressly release Chabad North Shore, its employees or officers from any claim or liability arising directly or indirectly from the enrolled program.

    I authorise Camp Gan Izzy to take the above child/ren on the excursions that are on the days that I have enroled them based on this excursion list here. 

    That my child will be photographed and videoed for the purposes of recording the wonderful services we offer, and sharing this information with our parent-body, and for encouraging the attendance of others within our community. If you specifically do not want pictures of video clips of your child/ren shared, please contact Chanie Schapiro - [email protected] to discuss.

  • PAYMENT INFORMATION

    Please note: All bookings are final and there are no refunds or cancellations. For more information please see terms and conditions . Additionally, all bookings made within 2 business days of the requested day, will incur a late fee of $20 per child.

    Payment is processed in full within 2 days of confirmation of this enrolment. You will be sent an email with a confirmed payment date. If CCS has not been confirmed before than, you will be charged regular rates at the  and once CCS is confirmed, the balance will be credited to your account for future attendances.

    Click here for more information about CCS.

  • Credit Card
  • Please note: Your spot is only confirmed upon receipt of a full confirmation email. This can usually be expected within 3 business days of submitting the form.

  • Should be Empty:
Secure This page uses TLS encryption to keep your data secure.