Chabad Five Towns Presidents Week Camp

Presidents Week Camp Information:

Tuesday, February 21 & Wednesday, February 22

10:00 AM - 4:15 PM l Grades 1 - 8

Lunch & Snacks Provided l $60 Per Day
Chabad Five Towns Winter Camp Application
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Number Of Children Registering*

Parent Information
Mother Name *

First NameLast Name
Email*
example@example.com
Cell Phone Number *
Please enter a valid phone number.
Father Name

First NameLast Name
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com

Emergency Contact
Name*

First NameLast Name
Email
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Relationship to camper *

Payment Type

Cash / CheckCredit Card
Payment:

Cash / CheckCredit Card

Presidents Week Camp Payment

Tuesday - Area 53

$60 Number of Children Attending

Wednesday - Sky Zone

$60 Number of Children Attending

Enter coupon

Total

$0.00

Payment
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Questions: Comments: Concerns:
We are looking forward to having your child join Presidents Week Camp!

Hadassah Geisinsky will be in touch with you with all camp updates - If you have any questions feel free to reach out to Hadassah - 516-458-3694
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