6 weeks Summer camp: • Ages: 18 Mon.- 4 Years/ Pre K • Dates: June 30- August 8 (we are closed on July 4th, Independence Day) • Hours: Mon- Thurs. 9:00am- 3:00pm. Fri- 9:00am-12:30pm ( no extended care) Option 1: Full session, 6 weeks: $2,100- Includes Snacks & Pizza lunch on Fridays Option 2: Weekly Registration: $375 per week- Includes: Snacks & Pizza lunch on Fridays Lunch Program: Lunch per week: $50 (Mon-Thurs) Gan Chabad Jewish Preschool Summer Camp Child 1 Information Child's Last Name:* Child's First Name:* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Child 2 Information Child's Last Name:(2) Child's First Name:(2) Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year SAFETY AGREEMENT:As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Gan Chabad of Valley Stream(known as Chabad for the Hebrew Speaking community) to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Gan Chabad of Valley Stream personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Gan Chabad of Valley Stream activities and that these pictures may be used for marketing purposes. Safety Agreement:* I except the safety agreement Signature on safety agreement:* Parent/ Legal Guardian I HAVE READ THE ABOVE SAFETY AGREEMENT AND I AGREE TO ALL THE TERMS. Date:* Month Day Year MAKE SURE TO OPEN THE FOLLOWING LINK AND SIGN THE PERMISSION FORM! After you submit the form, continue with registration until you submit it. Click HERE to sign the permission form (will open in a new window) I submitted the permission form * Yes PAYMENT AGREEMENTPayments are non-refundable. Refunds will be given until May 1. (not including credit card process fee) No refunds will be given due to absences. There is a $25 service charge for any returned checks. Payment Agreement:* I except the payment agreement Signature on payment agreement:* Parent/ Legal Guardian I HAVE READ THE ABOVE PAYMENT AGREEMENT AND I AGREE TO ALL THE TERMS. Date:* Month Day Year Below is my signature and confirmation that I have read and agree to the camp's terms & conditions Signature on terms & condition* Parent/ Legal Guardian I HAVE READ THE TERMS & CONDITIONS AND I AGREE TO ALL THE TERMS & CONDITIONS Full Session 6 weeks $2100- Includes Snacks & Fridays Pizza Lunch 1 Child2 children How may children? Lunch for 6 weeks $300- Mon-Thurs 1 child2 children How may children? If you choose to register for only some weeks and NOT for a full session, then choose which weeks you would like. It you choose the option "Full session 6 weeks," then DO NOT click on any other week below. Week #1: June 30- July 3 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #1 $50 1 child2 children How may children? Week #2: July 7-11 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #2 $50 1 child2 children How may children? Week #3: July 14-18 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #3 $50 1 child2 children How may children? Week #4: July 21-25 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #4 $50 1 child2 children How may children? Week #5: July 28-Aug. 1 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #5 $50 1 child2 children How may children? Week #6: Aug. 4-8 $375--Includes Snacks & Fridays Pizza Lunch 1 child2 children How may children? Lunch for week #6 $50 1 child2 children How may children? Payment:* Please note: By choosing CC option payment, you agree on paying an extra 3% prosses fee Credit Card Zelle , Check or Cash Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearAfter you submit the form, zelle your payment to: 516.359.2758. 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