Printed from ChabadofLA.com

Registration 5779

  • Camper Information

    Please use a separate form for each child.
  • Medical Information

  • Emergency Contact when parents are not available:

  • Medical & Release

  • Medical Authorization
    I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

    Trip Authorization
    I give permission for my child to go on field trips. I release Camp Gan Israel of Hancock Park, Congregation Levy Yitzchok, Bais Chaya Mushka and all individuals from liability in case of accident during activities related to our Summer Program, as long as normal safety procedures have been taken.

    Transportation Authorization
    I give permission for my child to ride on the Bus, Van or Car of Camp Gan Israel of Hancock Park. I release Camp Gan Israel, Congregation Levy Yitzchok, Bais Chaya Mushka and all individuals from liability in case of accident during activities related to our Summer Program, as long as normal safety procedures have been taken.

  • Payment Information:

    When you press submit, you credit card will be charged.
  • $0.00

    I would like to pay today:
  • Credit Card
    Billing Address
  • Should be Empty:
Secure This page uses TLS encryption to keep your data secure.