BMC Shabbaton

Child's Name*
First Name Last Name
I hereby authorize my daughter to go on the BMC shabbaton, in Upstate NY, March 11 through March 12, 2025 with Mushky and Shaina Hecht*
First Name Last Name
Parent Phone Number*
Please provide information regarding any medical needs or anything else we should know to best support your daughter
In case of an emergency, we will try and reach you on the phone numbers you provided. If we can't successfully reach you, please list another authorized person that we should contact*
First Name Last Name
Additional Emergency Contact Phone Number*
In case of an emergency I hereby authorize Chabad's certified staff, or the local hospital, to provide any first aid or emergency care deemed necessary for my child.*
First Name Last Name
To help cover the expenses of the Shabbaton weekend, there is charge of $75 per girl. The actual cost per girl is $250.

We understand that each family has different financial abilities and we therefore leave it to your discretion.
Payment*

75250360 Help Sponsor
Total

$0.00

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We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

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