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	CGI 2026 Registration - Chabad of Northern Nevada
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			<h1 class="article-header__title js-article-title js-page-title">CGI 2026 Registration</h1>
		
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","55_message":"If yes, please explain.","55_labelAlign":"Auto","55_required":"No","55_cols":40,"55_rows":6,"55_validation":"None","55_entryLimit":"None-0","55_maxsize":"","55_defaultValue":"","55_subLabel":"","55_hint":"","55_description":"","55_readonly":"No","55_wysiwyg":"Disable","55_name":"input55","55_qid":55,"55_type":"control_textarea","55_order":31,"31_text":"Is there anything else we need to know about your child?","31_message":"","31_labelAlign":"Auto","31_required":"No","31_cols":40,"31_rows":6,"31_validation":"None","31_entryLimit":"None-0","31_maxsize":"","31_defaultValue":"","31_subLabel":"","31_hint":"","31_description":"","31_readonly":"No","31_wysiwyg":"Disable","31_name":"input31","31_qid":31,"31_type":"control_textarea","31_order":32,"87_text":"When will your child be attending?","87_message":"","87_labelAlign":"Auto","87_required":"Yes","87_options":"Entire Session 6/29-7/17|Week 1 6/29-7/2 (camp closed Friday 7/3)|Week 2 7/6-7/10|Week 3 7/13-7/17","87_special":"None","87_allowOther":"No","87_otherText":"Other","87_calculateOther":"No","87_spreadCols":"1","87_selected":"","87_minSelection":"","87_maxSelection":"","87_description":"","87_name":"input87","87_qid":87,"87_type":"control_checkbox","87_order":33,"87_pricing":"0|0|0|0","59_text":"Will you be applying for a scholarship?","59_message":"Scholarship application can be found at chabadnorthernnevada.com/scholarship","59_labelAlign":"Auto","59_required":"Yes","59_options":"Yes|No","59_special":"None","59_allowOther":"No","59_otherText":"Other","59_calculateOther":"No","59_selected":"","59_spreadCols":"1","59_description":"","59_name":"input59","59_qid":59,"59_type":"control_radio","59_order":34,"47_text":"Permissions","47_message":"I allow Camp Gan Israel...","47_labelAlign":"Auto","47_required":"Yes","47_options":"In the event of an emergency, to seek medical help for my child, at my expense.","47_special":"None","47_allowOther":"No","47_otherText":"Other","47_calculateOther":"No","47_spreadCols":"1","47_selected":"","47_minSelection":"","47_maxSelection":"","47_description":"","47_name":"input47","47_qid":47,"47_type":"control_checkbox","47_order":35,"92_text":"","92_message":"","92_labelAlign":"Auto","92_required":"Yes","92_options":"To take photos of my child which may be included in camp newsletters and publicity.","92_special":"None","92_allowOther":"No","92_otherText":"Other","92_calculateOther":"No","92_spreadCols":"1","92_selected":"","92_minSelection":"","92_maxSelection":"","92_description":"","92_name":"input92","92_qid":92,"92_type":"control_checkbox","92_order":36,"93_text":"","93_message":"","93_labelAlign":"Auto","93_required":"Yes","93_options":"To transport my child and have my child participate in all trips.","93_special":"None","93_allowOther":"No","93_otherText":"Other","93_calculateOther":"No","93_spreadCols":"1","93_selected":"","93_minSelection":"","93_maxSelection":"","93_description":"","93_name":"input93","93_qid":93,"93_type":"control_checkbox","93_order":37,"86_text":"Swim Specifications","86_message":"","86_labelAlign":"Auto","86_required":"Yes","86_options":"My child is not swimming proficient and needs to wear a life jacket in the pool area.|I understand my child will be swim tested by the lifeguard staff. 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<form class="userform-form" action="" method="post" name="form_5374060" id="5374060" accept-charset="utf-8"><input type="hidden" name="formID" value="5374060" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_61"><div id="cid_61" class="form-input-wide"> <div id="text_61" class="form-html"><p>We are so excited to announce the opening of Camp Gan Israel's 2026 Session. We have a jam packed schedule of fun and exciting activities, on site enrichment and trips for your child, giving children a wide variety of opportunities each day for a fun and engaging summer.</p>

<p>Camp will run for three weeks beginning June 29 - July 17. Camp is closed Friday, July 3rd. Camp runs 9:00 a.m.-3:30 p.m. with optional aftercare Monday-Thursday 3:30-5:00 p.m. There are a limited amount of aftercare slots and we will only be able to offer it to families that sign up for it during the registration process on the <a href="/article.asp?AID=6782914">Tuition Payment Form</a>.</p>

<p>We are fortunate to be able to offer a limited amount of scholarships, so <a href="http://www.ChabadNorthernNevada.com/Article.asp?AID=4372753">apply</a> today! </p>

<p>If you have any questions regarding camp, please do not hesitate to contact Doba at doba@chabadnorthernnevada.com</p>
</div> </div></li><li id="cid_33" class="form-input-wide"> <div class="form-header-group"><h2 id="header_33" class="form-header">Personal Information</h2></div> </li><li class="form-line" id="id_1"><div class="form-label-left" id="label_1"><label for="input_1"> Child's First Name<span class="form-required">*</span> </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_1" name="q1_input1" size="20" value="" /> </div></li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Child's Last Name<span class="form-required">*</span> </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_12" name="q12_input12" size="20" value="" /> </div></li><li class="form-line" id="id_3"><div class="form-label-left" id="label_3"><label for="input_3"> Hebrew Name </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_3" name="q3_input3" size="20" value="" /> </div></li><li class="form-line" id="id_32"><div class="form-label-left" id="label_32"><label for="input_32"> Birth Date<span class="form-required">*</span> </label><label class="label-message" for="input_32"> Camp Gan Israel is currently taking children ages 5*-12**.  *Child must be entering Kindergarten and sit on a bus. **Special CKids Bunk for ages 9-12.</label></div><div id="cid_32" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q32_birthDate[month]" id="input_32_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_32_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q32_birthDate[day]" id="input_32_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_32_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q32_birthDate[year]" id="input_32_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_32_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Time of Birth </label><label class="label-message" for="input_6"> Used to calculate Jewish birthday</label></div><div id="cid_6" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_6" name="q6_input6" size="20" value="" /> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Home Address<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_7" name="q7_input7" size="20" value="" /> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Mother's Name<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_8" name="q8_input8" size="20" value="" /> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Mother's Address<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_9" name="q9_input9"><option value=""></option><option value="Same as child">Same as child</option><option value="Different from child">Different from child</option></select> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Address if Different </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_10" name="q10_input10" size="20" value="" /> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Mother's Cell Number<span class="form-required">*</span> </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_13" name="q13_input13" size="20" value="" /> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Mother's Work Contact Information </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_14" name="q14_input14" size="20" value="" /> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Father's Name<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_15" name="q15_input15" size="20" value="" /> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Father's Address<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_17" name="q17_input17"><option value=""></option><option value="Same as child">Same as child</option><option value="Different from child">Different from child</option></select> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Address if Different </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_16" name="q16_input16" size="20" value="" /> </div></li><li class="form-line" id="id_62"><div class="form-label-left" id="label_62"><label for="input_62"> Father's Cell Number<span class="form-required">*</span> </label><label class="label-message" for="input_62"> </label></div><div id="cid_62" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_62" name="q62_input62" size="20" value="" /> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Father's Work Contact Information </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_18" name="q18_input18" size="20" value="" /> </div></li><li class="form-line" id="id_94"><div class="form-label-left" id="label_94"><label for="input_94"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_94"> Please input the preferred email for CGI to be in contact with you.</label></div><div id="cid_94" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_94" name="q94_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> Emergency Contact Name<span class="form-required">*</span> </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_11" name="q11_input11" size="20" value="" /> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Emergency Contact Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_19" name="q19_input19" size="20" value="" /> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Emergency Contact Relationship to child<span class="form-required">*</span> </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_20" name="q20_input20" size="20" value="" /> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> I allow my child to be picked up by:<span class="form-required">*</span> </label><label class="label-message" for="input_21"> Please list name, relationship to the child and phone number for each person.</label></div><div id="cid_21" class="form-input"> <textarea id="input_21" class="form-textarea validate[required]" name="q21_input21" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> Health Insurance Policy Information<span class="form-required">*</span> </label><label class="label-message" for="input_22"> Please list name and number of policy.</label></div><div id="cid_22" class="form-input"> <textarea id="input_22" class="form-textarea validate[required]" name="q22_input22" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_24"><div class="form-label-left" id="label_24"><label for="input_24"> Does your child have any medical conditions?<span class="form-required">*</span> </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_24_0" name="q24_input24" value="Yes" /><label id="label_input_24_0" for="input_24_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_24_1" name="q24_input24" value="No" /><label id="label_input_24_1" for="input_24_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> If yes, list conditions here: </label><label class="label-message" for="input_27"> Please include any pertinent protocols.</label></div><div id="cid_27" class="form-input"> <textarea id="input_27" class="form-textarea" name="q27_input27" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Does your child have any allergies?<span class="form-required">*</span> </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_26_0" name="q26_input26" value="Yes" /><label id="label_input_26_0" for="input_26_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_26_1" name="q26_input26" value="No" /><label id="label_input_26_1" for="input_26_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> If yes, list protocol here: </label><label class="label-message" for="input_25"> Please include the protocol of how an allergic reaction should be dealt with.</label></div><div id="cid_25" class="form-input"> <textarea id="input_25" class="form-textarea" name="q25_input25" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_30"><div class="form-label-left" id="label_30"><label for="input_30"> Has your child had any serious injuries, illnesses or surgeries within the past year?<span class="form-required">*</span> </label><label class="label-message" for="input_30"> </label></div><div id="cid_30" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_30_0" name="q30_input30" value="Yes" /><label id="label_input_30_0" for="input_30_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_30_1" name="q30_input30" value="No" /><label id="label_input_30_1" for="input_30_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_29"><div class="form-label-left" id="label_29"><label for="input_29"> If yes, list here: </label><label class="label-message" for="input_29"> </label></div><div id="cid_29" class="form-input"> <textarea id="input_29" class="form-textarea" name="q29_input29" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_55"><div class="form-label-left" id="label_55"><label for="input_55"> Does your child have any Behavioral Concerns?  </label><label class="label-message" for="input_55"> If yes, please explain.</label></div><div id="cid_55" class="form-input"> <textarea id="input_55" class="form-textarea" name="q55_input55" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_31"><div class="form-label-left" id="label_31"><label for="input_31"> Is there anything else we need to know about your child? </label><label class="label-message" for="input_31"> </label></div><div id="cid_31" class="form-input"> <textarea id="input_31" class="form-textarea" name="q31_input31" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_87"><div class="form-label-left" id="label_87"><label for="input_87"> When will your child be attending?<span class="form-required">*</span> </label><label class="label-message" for="input_87"> </label></div><div id="cid_87" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_87_0" name="q87_input87[]" value="Entire Session 6/29-7/17" /><label id="label_input_87_0" for="input_87_0"><span>Entire Session 6/29-7/17</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_87_1" name="q87_input87[]" value="Week 1 6/29-7/2 (camp closed Friday 7/3)" /><label id="label_input_87_1" for="input_87_1"><span>Week 1 6/29-7/2 (camp closed Friday 7/3)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_87_2" name="q87_input87[]" value="Week 2 7/6-7/10" /><label id="label_input_87_2" for="input_87_2"><span>Week 2 7/6-7/10</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_87_3" name="q87_input87[]" value="Week 3 7/13-7/17" /><label id="label_input_87_3" for="input_87_3"><span>Week 3 7/13-7/17</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_59"><div class="form-label-left" id="label_59"><label for="input_59"> Will you be applying for a scholarship?<span class="form-required">*</span> </label><label class="label-message" for="input_59"> Scholarship application can be found at chabadnorthernnevada.com/scholarship</label></div><div id="cid_59" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_59_0" name="q59_input59" value="Yes" /><label id="label_input_59_0" for="input_59_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_59_1" name="q59_input59" value="No" /><label id="label_input_59_1" for="input_59_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_47"><div class="form-label-left" id="label_47"><label for="input_47"> Permissions<span class="form-required">*</span> </label><label class="label-message" for="input_47"> I allow Camp Gan Israel...</label></div><div id="cid_47" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_47_0" name="q47_input47[]" value="In the event of an emergency, to seek medical help for my child, at my expense." /><label id="label_input_47_0" for="input_47_0"><span>In the event of an emergency, to seek medical help for my child, at my expense.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_92"><div class="form-label-left" id="label_92"><label for="input_92"> <span class="form-required">*</span> </label><label class="label-message" for="input_92"> </label></div><div id="cid_92" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_92_0" name="q92_input92[]" value="To take photos of my child which may be included in camp newsletters and publicity." /><label id="label_input_92_0" for="input_92_0"><span>To take photos of my child which may be included in camp newsletters and publicity.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_93"><div class="form-label-left" id="label_93"><label for="input_93"> <span class="form-required">*</span> </label><label class="label-message" for="input_93"> </label></div><div id="cid_93" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_93_0" name="q93_input93[]" value="To transport my child and have my child participate in all trips." /><label id="label_input_93_0" for="input_93_0"><span>To transport my child and have my child participate in all trips.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_86"><div class="form-label-left" id="label_86"><label for="input_86"> Swim Specifications<span class="form-required">*</span> </label><label class="label-message" for="input_86"> </label></div><div id="cid_86" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_86_0" name="q86_input86" value="My child is not swimming proficient and needs to wear a life jacket in the pool area." /><label id="label_input_86_0" for="input_86_0"><span>My child is not swimming proficient and needs to wear a life jacket in the pool area.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_86_1" name="q86_input86" value="I understand my child will be swim tested by the lifeguard staff. If my child passes, I understand that my child will be allowed to go in the pool without a life jacket. I DO NOT let my child use the diving board." /><label id="label_input_86_1" for="input_86_1"><span>I understand my child will be swim tested by the lifeguard staff. If my child passes, I understand that my child will be allowed to go in the pool without a life jacket. I DO NOT let my child use the diving board.</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_86_2" name="q86_input86" value="I understand my child will be swim tested by the lifeguard staff. If my child passes, I understand that my child will be allowed to go in the pool without a life jacket. I DO let my child use the diving board." /><label id="label_input_86_2" for="input_86_2"><span>I understand my child will be swim tested by the lifeguard staff. If my child passes, I understand that my child will be allowed to go in the pool without a life jacket. I DO let my child use the diving board.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Sign and Date<span class="form-required">*</span> </label><label class="label-message" for="input_48"> I, the undersigned, as parent/guardian of ___________________, for and inconsideration of the agreement with Aleph Academy and Chabad of Northern Nevada release, acquit, discharge and hold harmless Aleph Academy and Chabad of Northern Nevada and its agents, employees, representatives, successors and assigns, for all manners of claims, demands and damages of every kind and nature whatsoever, which the undersigned my now or in the future have against Aleph Academy/Chabad of Northern Nevada and its agents, employees, representatives, successors or assigns on account of any personal injuries, physical or mental condition, known or unknown, to the person and the treatment thereof, as successors or assigns, including but not limited to their negligence or gross negligence in executing the services above described or in any way incidental thereto. I, the undersigned, do hereby release, indemnify, and hold harmless Aleph Academy/Chabad of Northern Nevada and its affiliates, agents and subsidiaries from any and all actions or claims as a result of any injuries to my child or any other children while participating in Aleph Academy.</label></div><div id="cid_48" class="form-input"> <textarea id="input_48" class="form-textarea validate[required]" name="q48_input48" cols="40" rows="6"></textarea> </div></li><li id="cid_89" class="form-input-wide"> <div class="form-header-group"><h2 id="header_89" class="form-header">Registration Fee Payment</h2></div> </li><li class="form-line" id="id_64"><div class="form-label-left" id="label_64"><label for="input_64"> Registration Fee<span class="form-required">*</span> </label><label class="label-message" for="input_64"> Due at Registration</label></div><div id="cid_64" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_64_0" name="q64_input64" value="$30" /><label id="label_input_64_0" for="input_64_0"><span>$30</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_57"><div class="form-label-left" id="label_57"><label for="input_57"> Total Due Today </label></div><div id="cid_57" class="form-input"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_58"><div class="form-label-left" id="label_58"><label for="input_58"> Payment </label><label class="label-message" for="input_58"> </label></div><div id="cid_58" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q58_payment[cc_type]" id="input_58_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q58_payment[cc_number]" id="input_58_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_58_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q58_payment[cc_ccv]" id="input_58_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_58_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q58_payment[cc_nameOnCard]" id="input_58_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_58_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card "><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q58_payment[cc_exp_month]" id="input_58_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_58_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q58_payment[cc_exp_year]" id="input_58_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_58_cc_exp_year" id="sublabel_cc_exp_year">Expiration 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<p>Scholarships will be awarded in May. All tuition must be paid in full by May 20th.</p>
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