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Family Information
Family Name Fathers Name Mothers Name
Fathers Cell Mother Cell     Home Phone
Street Address State ZIP
Mothers Email Fathers Email    
Full Name Hebrew Name   Called By
Nationality Passport country of issue   Passport Number

I confirm my daughter has Health Insurance that is valid in South Africa 
School Information
Name of School your child attends  
Principal's Name  
School Tel #  
Principal's Email   
Reference Name (Not a family member)  
Reference Email  
Reference Tel #  

I hereby grant permission  to contact my child's school as a reference.


Payment Info
No application will be processed without credit card details.                       
Your card will only be charged once your child is accepted. It will then be charged an initial amount of $500 which will secure your child's place in camp. This amount will come of the balance off the camp fees. Full payment is required before camp begins. 

The cost for camp is $2850 + Airfare
Credit Card
Card Number
Expiry Date
CCV (3 digits on back)



I give my permission to use the photograph of my child as well as myself for promotional purposes.

My child has my permission to participate in SA Travel Camp. I understand that this program includes field trips and activities off the premises.

I understand that in case of emergency and I am unable to be contacted, I give permission to Chabad Youth to authorize any emergency action necessary to insure the safety of my child.

I understand that by participating in any SA Travel Camp activities and use of any recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities to be conducted by the camp, I/ We as an individual or as a parent or guardian of the participants named herein, assume all risk and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless the Camp, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at or conducted by the camp

I understand that all applications are non refundable.

I understand that by enrolling in SA Travel Camp I am agreeing to abide by all its policies.