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CBS Camp Chaverim Registration 2020

Camper Information:

Parent #1 Information:

Parent #2 Information:

Emergency Contact Information:

Person(s) OTHER THAN PARENTS/GUARDIANS in case parents are unable to be reached.

Person(s) OTHER THAN PARENTS authorized to pick up camper:

Medical Information:

Please list any allergies your child has. If none, list "N/A"

Please list any medications your child is taking and the frequency. If none, list "N/A"

Permission and Medical Release Form:

I/We hereby give permission for my child to be transported by camp transportation and to be supervised by camp staff and volunteers during all camp programs and field trips.  My child may participate in all camp activities.  I agree to abide by all Camp Chaverim rules, policies and regulations. I acknowledge that photos/video will be taken during camp for promotional purposes.

I/We, the undersigned, parent(s) or guardian(s) of:

a minor, do hereby authorize the directors of Camp Chaverim and Congregation Beth Shalom of Napa Valley, or their authorized representatives, as agents for the undersigned, to consent to medical treatment by a state licensed physician, or staff of a licensed hospital to be administered to my child in the event of accident, injury, sickness, etc., until such time as I may be contacted.  I also assume the responsibility for the payment of any such treatment.  This release shall remain in effect at all times during Camp Chaverim Summer Session 2020.

Registration Deadline: May 15, 2020

Early registration is recommended to reserve your child’s spot. 

Refunds will not be made for campers who withdraw from camp after June 1st, unless due to serious illness.

Tuition & Payment Information:

Daily snack, Camp Chaverim T-shirt, and all activities are included in camp tuition.

NEW!!! TEEN LEADERSHIP INTERNSHIP (Entering 7-10th grade in Fall ’20) 
If your teen is interested in being a part of our Teen Leadership Internship Program please contact Hylah at 415-302-4115 or for detailed information.  

Methods of Payment:

Select applicable discounts:
Total Amount Due

Please Sign and click the Submit button below to proceed to the payment page. 

You will receive an invoice if you have a Special Payment Arrangement

Signature (please type full name)
Tue, July 14 2020 22 Tammuz 5780