Child Information
Last Name
  First Name
  Hebrew Name
Gender
  DOB
   Home Phone
Address
   City, State, Zip
   Nearest Cross Streets
         
Sibling 1 Name
  Age
  School Attending
Sibling 2 Name
  Age
  School Attending
         
Parent Information
Mother
Mother's Name
   Hebrew Name
  Occupation
Firm Name
  Firm Address
  Firm Phone
Cell
  Email Address
   Country of Origin
Father
Father's Name
   Hebrew Name
  Occupation
Firm Name
  Firm Address
  Firm Phone
Cell
  Email Address
   Country of Origin
         
General Information
Is your child currently receiving any services through EI or CPSE?
 Yes No  -  If Yes, please explain:
Is your family affiliated with a congregation?
If yes, which one?
Does the child live with both natural parents?
Is the child's natural mother Jewish?
Are there any adoptions in your family?
Are there any Conversions in your family?
You may arrange to discuss these issues with our Rabbi
         
Number of Days   Length of Day   Sessions
2 Days: Tuesday & Thursday    Half Day 9:00 - 12:30pm   First Session: June 27 - July 18 (3 Weeks)
3 Days: Monday, Wednesday & Friday   Full Day  9:00am - 3:00pm     Second Session: July 19 - August 8 (3 Weeks)
5 Days: Monday - Friday        
 
How did you hear about Chabad Israel Kiddie Camp?