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Parent's Info
First Name
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Last Name
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Phone Number
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Email
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Street Address
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City
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Postal Code
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State/Province
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Camper
How many days are you registering for? (75$ Per Day)
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1
2
3
4
5
6
7
Please list which days
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First Name
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Last Name
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Gender
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Birth Date
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Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Shirt Size
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X-Small
Small
Medium
Large
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Select Group
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Torah Tots: Pre-k - 1st Grade
Mitzvah Mavens: Grades 2-3
Simcha Scouts: Grades 4-5
CITs: Grades 6-8
You have the same address as:
Same address as parent
Street Address
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City
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Postal Code
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State/Province
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Name any Allergies
List any medical conditions we should be aware of
Emergency Contact Info
First Name
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Last Name
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Cell Number
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Work Number
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Email
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Gan Israel Berkeley
office@chabadberkeley.org
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(510) 540-5824
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