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CGI Brentwood Summer Camp Registration 5786 2026

Camper's Name*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
Gender*
Current School
Can Your Child Participate In Physical Activities?
Does Your Child Currently Recieve Any of the Following services?

OTPTBT
Allergies/ Medical Condition
Does Your Child Read Hebrew?
Any Pertinent Information Regarding Your Child We Should Know About?
Doctor's Name*
First Name Last Name
Doctor Phone*

Area Code Phone Number
Camper's Name (Child 2)
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Gender
Current School
Can Your Child Participate In Physical Activity?
Does Your Child Currenttly Recieve Any of the Following services?

OTPTBT
Allergies/ Medical Conditions
Does Your Child Read Hebrew?
Any Pertinent Information Reguarding Your Child We Should Know?
Doctor's Name
First Name Last Name
Doctor Phone

Area Code Phone Number
Mother's information*
First Name Last Name
Mother's Hebrew Name*
Mothers Hebrew Name Mothers Mothers Hebrew Name
Home Phone*

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
E-mail*
Father's information*
First Name & Hebrew Name Last Name
Home Phone*

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
E-mail*

Address*

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

Camp Fee* Full Camp $2050/ Week $475

FULL CAMP/ June 29 - July 29Week 1/ June 29 - July 3Week 2/ July 6 - July 10Week 3/ July 13 - July 17Week 4/ July 20 - July 24Week5/ July 27 - 29
Camp Fee - Child 2 Full Camp $1800 // Week $475

FULL CAMP/ June 29 - July 29Week 1/ June 29 - July 4Week 2/ July 6 - July 10Week 3/ July 13 - July 17Week 4/ July 20 - July 24Week 5 / July 27 - 29
Registration Fee*

$50
Total

$50.00

Payment

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Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates by email
*

I/We understand that Chabad of Brentwood reserves the right to refuse admission to any child at any time in the event that tuition is not paid as agreed. I/We give permission for my/our child’s photo to be used for advertising purposes by Chabad of Brentwood and Chabad of California.  I/we authorize any adult acting on behalf of the Chabad of Brentwood to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Chabad of Brentwood will try to communicate with me prior to such treatment.
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CGI Brentwood Summer 5786

Camp Updates

Camp Dates- Summer 5786/2026!

June 29- July 29

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