Scholarship Application - Chabad Jewish Center of Troy

CHILD'S INFORMATION

Number of Children being registered*

Full Name, Child 1*

First Name Last Name

Birth Date*

Month Day Year

Hebrew Name

First Name Last Name

Gender

MaleFemale

Does your child have any allergies (food, medication)*

Please let us know your child's swimming ability?*

Never been in the water beforeBeginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Select Camp T-shirt size*

Please choose week or two of attendance*

Week 1: Monday, August 3rd - Friday, August 7th, 2026Week 2: Monday, August 10th - Friday, August 14th, 2026

Full Name, Child 2*

First Name Last Name

Birth Date*

Month Day Year

Hebrew Name

First Name Last Name

Gender

MaleFemale

Does your child have any allergies (food, medication)*

Please let us know your child's swimming ability?*

Never been in the water beforeBeginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Select Camp T-shirt size*

Please choose week or two of attendance*

Week 1: Monday, August 3rd - Friday, August 7th, 2026Week 2: Monday, August 10th - Friday, August 14th, 2026

Full Name, Child 3*

First Name Last Name

Birth Date*

Month Day Year

Hebrew Name

First Name Last Name

Gender

MaleFemale

Does your child have any allergies (food, medication)*

Please let us know your child's swimming ability?*

Never been in the water beforeBeginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Select Camp T-shirt size*

Please choose week or two of attendance*

Week 1: Monday, August 3rd - Friday, August 7th, 2026Week 2: Monday, August 10th - Friday, August 14th, 2026

Full Name, Child 4*

First Name Last Name

Birth Date*

Month Day Year

Hebrew Name

First Name Last Name

Gender

MaleFemale

Does your child have any allergies (food, medication)*

Please let us know your child's swimming ability?*

Never been in the water beforeBeginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Select Camp T-shirt size*

Please choose week or two of attendance*

Week 1: Monday, August 3rd - Friday, August 7th, 2026Week 2: Monday, August 10th - Friday, August 14th, 2026

PARENT'S INFORMATION

FATHER'S INFO

Full Name*

First Name Last Name

Phone Number*

E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Religion

Jewish by birthJewish by conversionNot Jewish

MOTHER'S INFO

Full Name*

First Name Last Name

Phone Number*

E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Religion

Jewish by birthJewish by conversionNot Jewish

EMERGENCY INFORMATION

Full Name*

First Name Last Name

Phone Number*

Relationship to your child*

I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Camp Gan Israel will undertake such a decision.

MORE INFORMATION

Permissions* All of these must be selected. If you have a question or hesitation, please email to Rabbi Menachem.

I hereby give permission for my child to participate in all Camp Gan Israel activities and tripsI also hereby consent to the administration of Camp Gan Israel to take whatever medical meaures they deem necessary for my child, in the event of a medical EMERGENCY in which they can't reach meI also authorize Camp Gan Israel to have and use photographs, slides and videos of the person named on this application as needed for educational and public relations programs

Signature of Parent or Guardian

Date and time

Month Day Year

at Hour Minutes

SUBMISSION INFORMATION

Scholarship, please contact Rabbi Menachem [email protected]

I got approval from Rabbi Menachem CaytakI would like to apply for Scholarship and I understand Grants are on a first come first serve basis.

Total

$0.00

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