Internet banner online.jpg

 

* Marks required fields 

Camper and Parent Information

Child's Name:*
Hebrew Name:*
Last Name:*
Date Of Birth:*
 

 Contact Info
Home Number:*  
Email:*  
Address:*
 

 School Info
School:  
Grade:* 
 

Mum
Mother's Name:
Work Phone:
Mobile:
 

Dad
Father's Name:
Work Phone:
Mobile:
 

Emergency Contact
Name:*
Phone:*
Relationship:*
 

Doctor

Doctor's Name:*
Medical Centre:  
Phone:*   
 

 Allergies
Allergies:* 

 

 

I give permission for photos of my child to be taken and used for promotion of the camp. This includes means of website, brochure, posters and newsletters.

 

Yes    No  
Select Days the Child Will Be Attending (Minimum 2 Days)

 (To select more than 1 hold down Ctrl)
The Child may be picked up by:
1. Name:*
Relationship:*
2. Name:
Relationship:
Th
Medical Emergency
e Chi

In Case Of Medical Emergency whereby parents or legal guardians can not be reached, I hereby authorize the camp to take appropriate action:

My child is permitted Panadol:

Food/Medication Allergies, Please Specify:

Payment Information

Rates:   

Gan Izzy 

Per day: $65 (Tuesday, Thursday - excursion days $80)

Per week: $250

 

Tiny Tots 

Per day: $60            

Per Week: $200

 
Select Division

  
Amount
Card Type
Name on Card:
Credit Card No.
Expiry Date