Camp Sababa 2017 Registration
Welcome to Camp Sababa! We are so excited that you have chosen to be a part of Camp Sababa at Congregation Beth Israel this summer. If you are registering more than one camper, please start with the oldest first. Please check the Camp Sababa website for rates, dates, and much more information: www.bethisrael-pdx.org/education/camp-sababa

Questions?? Contact Sarah Reiter at the Education Office: 503-222-1069 or Sarah@bethisrael-pdx.org . In order to best prepare MITs for their leadership role, staff week (July 31st- August 4th) is mandatory for participation.

Camp Sababa
1972 NW Flanders St.
Portland, OR 97209

Gender Preference
Camper Name (first and last)
Your answer
Birthdate
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Grade in Fall 2017
T-shirt Size
Session(s)
Please select all weeks your camper will attend. See website for rates.
Required
If you have any questions or special circumstances regarding dates, please let us know here.
Your answer
Parent/Guardian Name I
Your answer
Parent/Guardian Name II
Your answer
Address
Your answer
Address II (if different than above)
Your answer
Home Phone
Your answer
Parent I Cell Phone
Your answer
Parent I Email
Your answer
Parent II Cell Phone
Your answer
Parent II Email
Your answer
Emergency contact name and number in the event that neither parent can be reached during camp hours.
Your answer
Additional emergency contact name and number in the event that neither parent can be reached during camp hours.
Your answer
Medical Insurance Carrier:
Your answer
Policy Holder Name:
Your answer
Group/Policy Number:
Your answer
Please check any of the following that apply to your camper.
If you checked any of the boxes above, please share any comments on the camper's particular needs/special circumstances that we should know about (confidential).
Your answer
To show my support of Jewish summer camp at CBI and to help other children attend the experience, I would like to make a tax-deductible donation. Please enter amount here:
Your answer
I give permission for Camp Sababa/Congregation Beth Israel to use my child(ren)'s photograph in publicity materials, which may include internet postings, the Bulletin, press releases and marketing materials.
Congregation Beth Israel and Camp Sababa are dedicated to creating a safe and welcoming community. Please read our Terms and Agreements below and provide a parent/guardian electronic signature.
Your answer
Today's Date:
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Terms and Agreements
Health and Safety:
I give permission to Congregation Beth Israel to provide routine health care and seek emergency medical treatment. In the event that I cannot be reached in an emergency, I give my permission to the physician selected by the adult staff to hospitalize, secure proper treatment for and order injections, anesthesia or surgery for my child. I recognize that I will be responsible for any costs incurred for this treatment.

Field Trip Transportation:
I give permission for Camper to be driven to and from the field trips or outings by authorized vehicles (e.g. bus, van, or automobile) providing transportation. I agree to indemnify and hold harmless Congregation Beth Israel, its employees, volunteers and the like from any harm which may come to Camper while they are driving to or from, or being driven to or from, the field trips or outings.

Indemnification:
I hereby release, discharge, and hold harmless Congregation Beth Israel, its employees, and the like, from any and all claims, lawsuits, or other legal causes of action, which relate to the Camper’s participation in programming, field trips, or the travel to and from the field trips.

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