Shabbat Camp Away

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WELCOME TO HAMERKAZ LAMDENI GRADE 3-4-5 KIDS SHABBAT CAMP AWAY REGISTRATION FORM
23-25th August 2024

* VERY LIMITED PLACES*

To ensure your place, please submit registrations no later than 16/8/2024. Late registrations will be placed on a waiting list.
Child's Personal Details
Full Name*

First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Gender*
Child's Grade*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parents' Details
Mother's Details
Mother's Name*

First Name Last Name
Mobile Number*
Phone Number
E-mail*
Same address as child*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Details
Father's Name*

First Name Last Name
Mobile Number*
Phone Number
E-mail*
Same address as child*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact Details
Full Name* (Other than Parents)

First Name Last Name
Mobile Number*
Other Person authorized to collect child or to contact in case of an emergency
Full Name

First Name Last Name
Mobile Number
Medical Details
Medicare Number*
Private Health Fund Name*
Private Health Insurance Number*
Doctor's Name*
Mobile Number*
Phone Number*
Does your child have any health conditions?*
If yes, please specify*
Does your child have any dietary restrictions?*
If yes, please specify*
My child may/will require medicine while at the program*
If yes, please specify medicine details*
*Please note: Medicine must be handed into our office prior to the program - clearly labeled with instructions.
Personal Care
Does your child get bus sick*
What do they take in the event that they get bus sick?*
Does your child have any issue with sleeping, settling to sleep, or sleepwalk?*
If yes, what can we do to address the matter?*
Does your child have a reference of who they want to bunk up with?*
What is your child's usual bed time?*
What time does your child usually rise on the weekend?*
What does your child enjoy for breakfast?*
Is there any food that your child ABSOLUTELY won't eat? If yes, please specify*
List 3 games your child enjoys playing that do not involve electrical components?*
Additional Questionaire

( Optional)
What makes your child feel anxious / happy/ sad?
What would you like your child to achieve in the experience?
Are there any family dynamics /situations/issues we should be aware of?
Is your child attending with a friend?
Any issues with friends we should be aware of?
Payment Details

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

The actual cost of the camp is close to $400 per child. However, as this is our inaugural camp, we are offering a special rate of $154 per child valid until 16/8/2024.

* Notes: All cancelations made after 16/8/2024 will incur a $72 fee.

* If you'd like to contribute to subsidizing the camp fees, please click here to make a donation.*
*

I authorize to charge the amount on my credit card on or after 16/8/2024.
Declarations:
*

Accidents: In the event of illness or injury to my child while attending the Shabbat Camp Away program of Hamerkaz Shelanu & Lamdeni School Inc., I authorize the coordinator or staff members in charge of my child to seek and obtain emergency medical, hospital, or ambulance services on my behalf if it is impractical to communicate with me.
*

Emergency Transport Authorization: In the event of a medical emergency where an ambulance is not immediately available, I hereby authorize Hamerkaz & Lamdeni designated staff to transport my child, using school or staff vehicles to the nearest medical facility for urgent care. I understand that this action will be taken solely to ensure the safety and well-being of my child in a timely manner.
*

Medication: I authorize the coordinator or staff members in charge to administer medication to my child in case of an emergency, according to the best judgment of the staff and in the best interest of my child's health and safety
*

Excursions/Transport: I give permission for my child to be transported and participate in all the adventurous activities and/or excursions organized as part of the Shabbat Camp Away program.
*

Liability: I agree to pay for any expenses that may occur as a result of injury/illness or any reckless damage caused by my child during Hamerkaz Lamdeni Shabbat Camp Away program.
*

Device Policy: I agree not to send any electrical devices with my child, except for a phone which will be held by Hamerkaz & Lamdeni staff in charge and made available for contact upon request or discretion.
*

WhatApps Group: I agree to be added to the Hamerkaz Lamdeni Shabbat Camp Away WhatsApp group. I understand that this group is for sharing important updates and information related to camp activities. I agree to use the group responsibly and respect the privacy of all members.
*

I certify that all the above information is true and correct, and agree to Lamdeni & Hamerkaz Shelanu's terms and conditions as per Policy Book (copy available at our office) and Camp Form.
I give permission for my child's photographs/videos to be used for promotional purposes.*

YesNo
* Thank you so much for registering for Hamerkaz Lamdeni Shabbat Camp Away! We look forward to making it a memorable experience! Upon registration, you will receive a Welcome Pack with more details *
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WELCOME TO HAMERKAZ LAMDENI GRADE 3-4-5 KIDS SHABBAT CAMP AWAY REGISTRATION FORM

Child's Personal Details

Parents' Details

Emergency Contact Details

Other Person authorized to collect child or to contact in case of an emergency

Medical Details

Personal Care

Additional Questionaire

Payment Details

Declarations: