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CAMP APPLICATION

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CAMP ADMISSIONS FORM

The dates for Camp Chabad Summer 2021 are June 28 – August 20

There is a childcare option for the week in between school and camp, June 21 – June 25

CELC will be closed from August 23-September 3rd for Cleaning & Teachers In Service Week

Please fill out the form below to begin the camp application process.

Child Name*
First Last
Hebrew Name (If Known)
How Should Your Child Be Called?
Gender*
- Boy
- Girl
DOB*
Date Format: MM slash DD slash YYYY
Time Of Birth
Age*
Home Phone*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent Information
Father's Name*
First Last
Father's Cell*
Father's Email*

Please note that Camp Chabad uses email as its primary means of communication. Please provide us with the email address you use most frequently
Occupation*
Business Name
Business Phone
Mother's Name*
First Last
Mother's Cell*
Mother's Email*

Please note that Camp Chabad uses email as its primary means of communication. Please provide us with the email address you use most frequently
Occupation*
Business Name
Business Phone
Marital Status (choose one option)*
- Married
- Separated
- Widowed
- Divorced
Does your child have any allergies or other medical condition, require medication, or any special abilities or disabilities we should be aware of?*
- Yes
- No
Please describe them and indicate special precautions or care needed.
Small Wonders (Birth - 18 Months)
- Full Day 6:30 AM - 7:00 PM
- Half Day 9:00 AM - 3:00 PM
Torah Tots (18 Months - 3 Years Old)
- EZPASS
- Full Day 9:00 AM- 3:00 PM
- Half Day 9:00 AM - 12:30 PM
Mitzvah Munchkins (3 Years Old - 5 Years Old)
- EZPASS
- Full Day 9:00 AM - 3:00 PM
- Half Day 9:00 AM - 1:00 PM
Which session will your child be attending camp?
- Childcare Session June 21-June 25
- Week 1 June 28- July 2
- Week 2 July 5 - July 9
- Week 3 July 12 - July 16
- Week 4 July 19 - July 23
- Week 5 July 26 - July 30
- Week 6 August 2 - August 6
- Week 7 August 9 - August 13
- Week 8 August 16 - August 20
- Childcare Session August 23-August 27 ( LIMITED AVAILABILITY)
Which days of the week would you like to register your child?
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Before/ After Care? ( Any hours before 9 am and after 3 pm)
- Yes
- No
If you are registering for EZPASS or any before/after care hours, please indicate all days and hours of childcare needed.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Monday Drop Off Time and Pick Up Time*
Please let us know when you are dropping off, and when you are picking up.
Tuesday Drop Off Time and Pick Up Time*
Please let us know when you are dropping off, and when you are picking up.
Wednesday Drop Off Time and Pick Up Time*
Please let us know when you are dropping off, and when you are picking up.
Thursday Drop Off Time and Pick Up Time*
Please let us know when you are dropping off, and when you are picking up.
Friday Drop Off Time and Pick Up Time*
Please let us know when you are dropping off, and when you are picking up.
In order for your child to start, we need the most current Health and Immunization forms on file. (If we have it from the 2020/21 CELC school year, you do not to resend it. ) Please email us if you need a new Universal Health Record form to fill out.
We look forward to a wonderful, safe and happy summer!

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