Sign up for camp, right here!

Please complete the following camp form and submit it to us.

Please note that this registration will not be processed without payment.

You can transfer directly into our account (details below) and then fax or email a copy of the deposit slip to us. Or you could phone our accounts department 021-434-3740 with your credit card details and make a payment that way.

Surname  
Name      
Age                       
Date of Birth  

Male Female (Tick one)
Tel. (Home)    
Tel. (Work)   
Cell.              
Email address

Home address

Postal address

Alternative emergency contact person
Emergency contact's number               
Child's Hebrew name                           
Mother's Hebrew name                        
School                                                  
Grade                                                   
Names and ages of siblings attending camp


Please indicate which friends of the same age and sex as your child your child would want to be grouped with:


Relevant health information


Name of house doctor  
Doctor's tel. number     

INDEMNITY AND WAIVER

Acting in my personal capacity as the parent/guardian of permit him/her to participate in the activities of the above  named Camp on the dates stated above, hereby absolving the organizers and any other person acting on their behalf from any liability whatsoever and however caused to the person of the camp and agree that neither I nor the camper shall have any claim of any nature whatsoever against the camp organizers or any of them in such event, from the time he/she leaves the starting point of the days activities until he/she returns to the starting point, whether on or off the camp premises including any and all outings and trips.

Date                        
Parent's full name  
                                                           


Lubavitch Foundation banking details:
Nedbank Sea Point
Account name: Lubavitch Foundation
Account number: 1069 238 392 
Branch code:      106909

Chabad Centre fax number: 021 434 2821