Camp Registration Form
Please complete this form to register your child for Summer 2020
Due to State regulation record requirements, please complete a new form for each child who will be in camp
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Email *
Last Name *
First name of Camper *
Grade entering in the Fall *
Date of Birth *
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Each week is a seperate session. Please select which weeks your camper is attending. *
Required
Street address *
City, State, Zip *
Father Cell Phone number
Mother Cell Phone number *
Emergency Contact Name and Phone Number *
Doctor's Name and Contact Info *
In case of accident or serious illness, I request the camp to contact me. If the camp is unable to reach me, I hereby authorize Torah Day Camp, Camp Chaverim Inc. to call the physician indicated below and to follow his instructions. If it is impossible to contact this physician, the camp may make any arrangements deemed necessary to have emergency medical treatment administered by a qualified physician or hospital.         This will authorize Torah Day Camp, 450 Elmgrove Avenue, Providence, Rhode Island, to have emergency medical treatment administered if necessary, by a physician or hospital.         If feasible, attempt will be made as soon as practicable to contact me.  In place of my signature I am checking the box below. *
Required
 I hereby grant permission for him/her to attend educational, social or athletic functions and field trips held on premises other than at the P.H.D.S., 450 Elmgrove Avenue, Providence, Rhode Island, which entail bus and/or other transportation, at our own risk, and without holding the Torah Day Camp, Camp Chaverim, Inc. responsible in any way. *
Required
I completed the T-shirt form *
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