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Information Details
First Name
*
Last Name
*
Parent Information Please fill out all parent information. If Parent is a single parent please enter NA.
Mother's Name
*
Mother's Cell Phone Number
*
Mother's Email
*
Father's Name
*
Father's Cell Phone Number
*
Father's Email
*
Are the natural parents of the child Jewish?
*
Both Parents
Mother Only
Father Only
Camper's Information
Camper's Full Name
*
Camper's Jewish Name
Camper's Address
*
Camper's Birth Date
*
Gender
*
Male
Female
Grade Entering September 2025
*
All Sizes are Youth
T-Shirt Size
*
XS
S
M
L
How did you hear about camp?
Event Fee(s)
*
Admission
-
$ 18.00
Event Sponsor
-
$ 180.00
Total
Payment Options
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Chabad of the South Hills - Jewish Center for Living & Learning
rabbi@chabadsh.com
|
412-344-2424
|
1701 McFarland Road Pittsburgh, PA 15216-1812
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