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Summer 2017 Online Registration is now open!

Camp runs for 4 weeks.

Monday, June 26 thru Friday, July 21.

Camp begins at 9:00 am and ends at 3:30 pm.

Pre-Care and After-Care are available.

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child. If you have any questions, please call Rabbi Levi at 803.237.7330

Camper/Parent Information
Name
  First
Middle Last  
Address
  Street
City State
Zip
Date of Birth
 

Age

Contact Info
  Phone
Email
 
School
  School
  Entering Grade:
Medical Info:
  Any Chronic Illness?
Any Medicine?
Other Medical info..  
Parents
Emergency
Contact
  Mom's Work#:
Mom's Cell #:

Dad's Work #:

Dad's Cell #:
Emergency Contact Info
  Name

Phone

Relationship  
Pediatrician
  Name

Phone

Address

 

Hospital:

  Which hospital would you want your child sent to in case of emergency?  
           
Tuition for Camp:
Reg. Price:
$225 per week
$900/ Four weeks
   
Early Bird:
$213.75 Per week
$855/ Four weeks
   
2nd Sibling & Early Bird:
$203.06  Per week $812.25/ Four weeks
Please indicate number of sessions your child will attend camp:
 
     
IMPORTANT
All forms must be completed and submitted before your child begins camp.

I will be paying the total sum of: $

Method of payment: Check Mastercard Visa

Credit Card Number: Expiration:

Security Code Zip Code:

Checks can be mailed to: Chabad of South Carolina, 2509 Decker Blvd Columbia, SC 29206

I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
   
  Date of Application:
 
 
 

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Jewish Summer Experience-Phone: 803.237.7330
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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