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Camp Gan Israel
REGISTER ONLINE
Please fill-in the form below carefully. When you press submit, this form will be sent to our office. Please use a seperate form for each child.
If you prefer not to pay online, please call our office on 07 3843 6770 and leave a message if necessary, or send a cheque payable to: Chabad Brisbane, PO Box 1257, Carindale QLD 4152.
| Family Information |
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Name
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First Name Family Name Hebrew Name
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Address
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Street Suburb State Post Code
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Date of Birth
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Date Month Year
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| School |
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School School Year 2012
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Contact Info
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Home Phone Family Email
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Child's Mother
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Mother's Name: Hebrew Name: Work Number: Mobile No:
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Child's Father
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Father's Name: Hebrew Name: Work Number: Mobile No:
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Emergency
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Name of Contact Phone Number Relationship
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Medical
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Name of Doctor Phone Number
Allergies
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| Please indicate the days your child will be attending: |
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Week 1
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Monday, 2 July, 2012
Tuesday, 3 July, 2012
Wednesday, 4 July, 2012
Thursday, 5 July, 2012
Friday, 6 July, 2012
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| Important |
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All forms must be completed and submitted before your child begins camp.
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I will be paying by:
Cheque (payable to Chabad Brisbane, PO Box 1257, Carindale QLD 4152)
Credit Card (fill-in details below
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