Camp Eitz Chaim Pre-Pesach Program Child's Name * First Name Last Name Grade * Kindergarten Primary First Second Phone * (###) ### #### Email * Emergency Contact * (###) ### #### Days Attending * Tuesday, Apr 8 $65 Wednesday, Apr 9 $65 Thursday, Apr 10 $65 Full Program Special (3 Days) $185 Are there any allergies or special accommodations we should be aware of? * No Yes By registering your child in our program, you and any legal guardian of your child give permission for the staff at CAMP EITZ CHAIM LLC to deal with any medical emergencies and make any necessary medical decisions, and agree not to hold CAMP EITZ CHAIM LLC liable for illness or injury, I agree to the terms and conditions as seen here. * I Agree I am aware of Camp Eitz Chaim’s dismissal times. Camp dismissal is from 3:15 to 3:30 daily. I understand that by failing to have my child(ren) picked up after this time, I will incur a charge according to the amount of waiting time. * I Agree If paying with credit card, please enter your card details below. Please note, there will be a 4% surcharge for credit card purchases. Your card will be charged at a later date. Please add your card number, expiration date, security code, and zip code. How did you hear about us? Thank you! Your application has been successfully submitted!
