Camp Registration Form

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Please complete this form to register your child for Summer 2022
If you are completing this form for multiple campers,
after completing the form once, just put the letter "A" in all of the boxes besides for the ones pertaining to the individual camper for the rest of the campers from your family.

Email *

Last Name *

First name of Camper *

Grade entering in the Fall *

Date of Birth *

YYYY

Street address *

City, State, Zip *

Father Cell Phone number

Mother Cell Phone number *

Emergency Contact Name and Phone Number *

Doctor's Name and Contact Info *

In case of accident or serious illness, I request the camp to contact me. If the camp is unable to reach me, I hereby authorize Torah Day Camp, Camp Chaverim Inc. to call the physician indicated below and to follow his instructions. If it is impossible to contact this physician, the camp may make any arrangements deemed necessary to have emergency medical treatment administered by a qualified physician or hospital. This will authorize Torah Day Camp, 450 Elmgrove Avenue, Providence, Rhode Island, to have emergency medical treatment administered if necessary, by a physician or hospital. If feasible, attempt will be made as soon as practicable to contact me. In place of my signature I am checking the box below. *

I hereby authorize Torah Day Camp, Camp Chaverim Inc. to make any arrangements necessary to treat my child in case of a medical emergency

Required

I hereby grant permission for him/her to attend educational, social or athletic functions and field trips held on premises other than at the P.H.D.S., 450 Elmgrove Avenue, Providence, Rhode Island, which entail bus and/or other transportation, at our own risk, and without holding the Torah Day Camp, Camp Chaverim, Inc. responsible in any way. *

I grant permission for him/her to attend educational, social or athletic functions and field trips without holding the Torah Day Camp, Camp Chaverim, Inc. responsible in any way.

Required

I agree that Rabbi Yudkowsky may dispose of as he see fit, any items left behind after my child leaves camp for the 2022 season. *

Yes

Required

Comments/Allergy Info

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