Child Information
Surname
Gender
 
Days Attending (£25 per day)
Monday Tuesday Wednesday Thursday Friday
 
Family Information
Address
 
Father
   
Mother
   
 
Medical & Emergency Info
Emergency Contact Information
 
Physician or Medical Facility
Phone
 
 
Medical Information
Does your child suffer from any of the following Asthma Rheumatism Hay Fever Epilepsy Diabetes Other (describe)
Please give full details of any conditions which may prevent full participation or involvement in rigorous activities or which requires medication. Should your child bring medication of any nature (including Asthma inhalers) to camp, please provide in writing the exact quantities of medication that should be given and when it should be taken, together with your consent for any staff member of CGI to give the medication.
Does your child suffer reactions to any of the following Insect Stings Certain Foods Medicines Other (describe)
Please describe any instructions that would be helpful in caring or for your child, or special medical information needed by the child’s care staff/provider.
Please provide any additional information. Please provide as much information as possible. The more information we have, the easier it will be to address complications, should they arise.
Is your child immunised against tetanus?

 
Registration Fee
I authorize Camp Gan Israel to charge my card in the amount of £120 (or £25 per day attending). Alternatively you can mail cheques payable to "Chabad" to Camp Director, 23 South Park Rd London SW19 8RR or pay via PayPal at paypal.me/chabadwimbledon.
Comments

The privacy and security of your personal data is important to us. Our Privacy Policy tells you what we do with the information you give us and about your rights, and can be viewed here.