RSVP 2 — Hunter Chabad

Child's Details

Child's Name

First Name

Last Name

Birth Date

YYYY

Hebrew Name (if known)

School

Grade

What grade is your child attending in 2024?

If other, please provide details below

Any Allergies / Medical Conditions?

If yes, please specify below

Allergies or Medical Conditions

Child 2

If you are enrolling more than one child, please provide their details below. Otherwise, please skip ahead to the 'Family Details' section.

Child 2 Name

First Name

Last Name

Child 2 Birth Date

YYYY

Child 2 Hebrew Name (if known)

Child 2 School

Child 2 Grade

Child 2 any allergies/ medical conditions?

Family Details

Parent 1 Name

First Name

Last Name

Parent 2 Name

First Name

Last Name

Parent 1 Contact Number

Please provide a valid phone number at which we can reach the child's parent/ guardian

Parent 2 Contact Number

Please provide a valid phone number at which we can reach the child's other parent (where applicable)

Please provide an email address at which to receive correspondence regarding this application and the child's progress through the program

Marital Status

Please describe the marital status of the child's parents

Address

Please provide the child's primary address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is the natural mother of the child Jewish?

Is the natural father of the child Jewish?

Are there any conversions in the family?

Please provide the name, relationship to child, year of conversion and institution/Rabbi with which the conversion took place for the individual(s)

Synagogue Affiliation (if any)

Emergency Details

In case of emergency, we will follow our emergency protocol, including attempting to notify a person of your choice. Please provide their details below and read the parent/ guardian declarationb for more details.

Emergency Contact

First Name

Last Name

Relationship to Child

Emergency Phone Number

Local GP Name

Local GP Phone

Declaration of Parent or Guardian

I hereby authorise Chabad of the Hunter and Central Coast leaders and staff to obtain any medical care necessary for my child(ren). I understand that in the case of emergency of any significant illness or injury, an attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child(ren) may participate in activities within and outside the Hunter Chabad and/or Newcastle Synagogue grounds. I authorise my child(ren) to participate in these activities. I hereby authorise Chabad of the Hunter and Central Coast to transport my child(ren) in their vehicles as necessary for camp activities. I hereby authorise Chabad of the Hunter and Central Coast to photograph my child(ren) and to use the photographs at their discretion for the purpose of the organisation.

Yes

Signed

Name of person filling in the form and agreeing to the above declaration

First Name

Last Name

Thank you for your application!

Please look out for an email regarding your application status in the next few days.

If you have any further questions or concerns, please don’t hesitate to reach out to us at info@hunterchabad.com