Winter Camp Enrollment

From Date

To Date

After November 21nd– $250 per Chanich

Shevet Chen Winter Camp 2019 (3rd - 9th / 9th-12th)

Start date: 1 Nov 2019
Regular price: $300
Registration closes on:: 8 Dec 2019

Price: Nov 1 to Dec 1 $275.00 per child. Dec 1 to Dec 8 $300.00 Per child. - Registration closes on December 8nd - Limited space! Please sign-up ASAP

How many children?*

Child's Name*

Date of Birth*

Grade*

School Attending*

Cell Phone

Email Address

Child's Facebook

Child's Instagram

Gender*

Male
Female

Have you attended camp before?*

Yes
No

List all allergies and dietary needs.

Medical Information

Policy Number*

Medical Information*

Medical Conditions

Medications

Grade*

#2 Child's Name*

#2 Date of Birth*

#2 Grade*

#2 School Attending*

#2 Cell Phone

#2 Email Address

#2 Child's Facebook

#2 Child's Instagram

#2 Gender*

Male
Female

#2 Have you attended camp before?*

Yes
No

#2 List all allergies and dietary needs.

#2 Medical Information

#2 Policy Number*

#2 Medical Information*

#2 Medical Conditions

#2 Medications

#2 Grade*

#3 Child's Name*

#3 Date of Birth*

#3 Grade*

#3 School Attending*

#3 Cell Phone

#3 Email Address

#3 Child's Facebook

#3 Child's Instagram

#3 Gender*

Male
Female

#3 Have you attended camp before?*

Yes
No

#3 List all allergies and dietary needs.

#3 Medical Information

#3 Policy Number*

#3 Medical Information*

#3 Medical Conditions

#3 Medications

#3 Grade*

#4 Child's Name*

#4 Date of Birth*

#4 Grade*

#4 School Attending*

#4 Cell Phone

#4 Email Address

#4 Child's Facebook

#4 Child's Instagram

#4 Gender*

Male
Female

#4 Have you attended camp before?*

Yes
No

#4 List all allergies and dietary needs.

#4 Medical Information

#4 Policy Number*

#4 Medical Information*

#4 Medical Conditions

#4 Medications

#4 Grade*

#5 Child's Name*

#5 Date of Birth*

#5 Grade*

#5 School Attending*

#5 Cell Phone

#5 Email Address

#5 Child's Facebook

#5 Child's Instagram

#5 Gender*

Male
Female

#5 Have you attended camp before?*

Yes
No

#5 List all allergies and dietary needs.

#5 Medical Information

#5 Policy Number*

#5 Medical Information*

#5 Medical Conditions

#5 Medications

#5 Grade*

Father's Name

Father's Occupation

Father's Phone

Father's Email

Father's Facebook

Mother's Name

Mother's Occupation

Mother's Phone

Mother's Email

Mother's Facebook

Health Insurance Upload

In order to complete your registration to Shevet Chen, please provide us with a photo copy o your health certificate / card. Simply take a photo with your phone, save to your computer and upload here by clicking on the ”choose file” button below to upload.

Choose File*

Consent, Release & Indemnification

The Parent/guardian signing below (“Parent”) on his/her’s behalf and on behalf of his/her’s child listed as a legal guardian and/or by power of attorney, hereby consents and gives permission for Parent’s son/ daughter t”) to participate in Winter machane, Canyon Creek camp, 41600 Lake Hughes Rd, Lake Hughed, CA 93532. the selected event or events which term shall include all activities and times the Event, arrival at and departure from the Event, and early dismissal or expulsion, if any, from the Event) on or about the following date(s) December 14th-16th and any date(s) to which such Event may be postponed.

In case of medical emergency involving Child, if Parent or another parent or guardian of Child cannot be reached, Parent hereby consents and gives permission to the physician selected by the Event Director to secure necessary and appropriate treatment for Child including hospitalization, anesthesia, surgery and any other emergency treatments deemed necessary by the physician. Parent agrees that Friends of Israel Scouts (“FOIS”) and the Israeli Scouts of Los Angeles (“ISLA”) are not responsible for any medical expenses incurred by or on behalf of Child, and authorizes FOIS to directly contact and deal with any health insurance company that may provide coverage for Child.

Parent and Child each understand and agree that the Event may include activities involving risk to Child. Parent and Child each represent that Child is in sound physical, mental and emotional health and fully able to participate in all Event activities without need of individualized or specialized attention, accommodation or medical regimen.

Parent and Child each agree that FOIS and/or ISLA has the right, in its sole discretion, to determine that Child may not participate in the Event or particular Event activities and, further, in its sole discretion, to determine that Child shall be dismissed or expelled from the Event.

Parent and Child each agree that FOIS and/or ISLA may use any photograph, image, likeness, statement or utterance of Child or Parent in any media, including the internet, for promotional or other purposes. In consideration for Child’s acceptance to participate in the Event, Parent and Child (and Parent on behalf of child), each for themselves, and their heirs, representatives, and next of kin, hereby forever release, waive, discharge and covenant not to sue, and agree to indemnify, defend and hold harmless FOIS and/or ISLA and each of their (individually or collectively) affiliates, related entities, officers, directors, employees, volunteers, members, agents and representatives (individually and collectively, “FOIS” “ISLA”) from and with respect to any and all claims, demands, actions, rights of action, and liability, damage, cost, loss and expense (including attorneys’ fees) of any kind whatsoever, past, present and future, both known and unknown, including those which have not yet arisen or matured, either in law or in equity, arising from, related to or in connection with Child’s participation in the Event, including but not limited to claims for negligence on the part of FOIS and/or ISLA or any other person or entity, claims under the Americans with Disabilities Act and all other anti-discrimination laws and regulations of any jurisdiction, claims for any delay, property damage, loss or theft, bodily injury, accident, illness, disease, death, mental or emotional injury, and all other claims for damage, cost, loss or expense of any nature whatsoever. Parent and Child each agree that this and any other agreement related to the Event, and all disputes, issues and matters arising from related to or in connection with the Event, are to be governed by the laws of the State, without giving effect to principles of conflicts of laws. Parent and Child each hereby consent to the exercise of personal jurisdiction over each of Parent and Child by the courts of the State and the federal court in connection with any matter arising from, related to or in connection with the Event, or this and any other agreement related thereto, and Parent and Child each further agree that such courts shall have exclusive jurisdiction over all such matters. If any term or provision hereof is determined to be invalid. 

THERE IS NO REFUND FOR REGISTRATION FEES, WHEN REQUESTED LESS THEN 72 HOURS BEFORE THE EVENT (EXCLUDING EMERGENCY MEDICAL REASONS WITH PHYSICIAN LETTER)

Parent and Child each have read, understand and agree to the above terms and conditions.

Terms*

I have read the terms and agree to them

Parent's Signature*

Date*

Payment Method

How many installment payments do you want?*

Price*

Price: $0.00

Total per times

$0.00

Address*

Street Address Address Line 2 City State ZIP Code

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

Enrollment