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? This page uses 128 bit SSL encryption to keep your data secure.