Shabbaton - Bar Mitzvah Club 202513-14 June 2025 Name of Bar Mitzvah Boy* First Name Last Name Parents names* Parent email* Mothers mobile* Fathers mobile Emergency contact name and number* Other than above numbers Any allergies or medical conditions we should know about? My child has an Epipen YesNo Any medication my child will need to take while on the Shabbaton (please detail time of administer and dose). Declaration of Parent or GuardianI hereby authorise Chabad House Glen Eira leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child may be participate in activities within and outside the Chabad grounds. I authorise my child to participate in these activities. I hereby authorise Chabad House Glen Eira to photograph my child and to use the photographs at their discretion. I agree to the above declaration Yes Declaration name* Shabbaton cost* $150 Total $0.00 Payment* ⚠ You have not yet connected a credit card processor.Credit Card We accept Visa, MasterCard Credit Card Number Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration Year Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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