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<form class="userform-form" action="" method="post" name="form_7196609" id="7196609" accept-charset="utf-8"><input type="hidden" name="formID" value="7196609" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_1" class="form-input-wide"> <div class="form-header-group"><h1 id="header_1" class="form-header">Camp Registration 2026</h1></div> </li><li class="form-line" id="id_67"><div id="cid_67" class="form-input-wide"> <div id="text_67" class="form-html"><p style="text-align:center"><img alt="" height="234" src="https://w2.chabad.org/media/images/1352/mwpU13527647.png" width="702" /></p>
</div> </div></li><li class="form-line" id="id_82"><div id="cid_82" class="form-input-wide"> <div id="text_82" class="form-html"><p style="text-align: center;"><span style="color:#000000;"><font face="Verdana, Geneva, sans-serif"><span style="font-size: 14px;">Contact Rivka@ChabadMinneapolis.com for any questions</span></font></span></p>
</div> </div></li><li class="form-line" id="id_83"><div id="cid_83" class="form-input-wide"> <div id="text_83" class="form-html"><p><span style="font-family:Verdana,Geneva,sans-serif;"><span style="font-size:14px;"><strong><span style="color:#e74c3c;">DATES:</span> <span style="color:#2980b9;">Session 1:</span></strong> June 15-19  <span style="color:#2980b9;"><strong>Session 2:</strong></span> June 22 -26</span></span></p>

<p>Join for one or both sessions! Each session features different recipes and trips</p>

<p><span style="font-family:Verdana,Geneva,sans-serif;"><span style="font-size:14px;"><span style="color:#e74c3c;"><strong>HOURS:</strong></span>  9:00am - 4:00pm   </span></span></p>

<p><span style="font-family:Verdana,Geneva,sans-serif;"><span style="font-size:14px;"><span style="color:#e74c3c;"><b>LOCATION:</b></span> Chabad Center for Jewish Life -  11033 Hillside Lane, Minnetonka</span></span></p>
</div> </div></li><li id="cid_4" class="form-input-wide"> <div class="form-header-group"><h3 id="header_4" class="form-header">CAMPER INFORMATION</h3></div> </li><li class="form-line" id="id_65"><div class="form-label-left" id="label_65"><label for="input_65"> Number of children enrolling:<span class="form-required">*</span> </label><label class="label-message" for="input_65"> </label></div><div id="cid_65" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_65" name="q65_input65"><option value=""></option><option value="1">1</option><option value="2">2</option><option value="3">3</option></select> </div></li><li id="cid_66" class="form-input-wide"> <div class="form-header-group"><h2 id="header_66" class="form-header">Child 1:</h2></div> </li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Name of Child </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q5_fullName[first]" id="first_5" autocomplete="given-name" />  <label class="form-sub-label" for="first_5" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q5_fullName[last]" id="last_5" autocomplete="family-name" />  <label class="form-sub-label" for="last_5" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Name child prefers to be called </label><label class="label-message" for="input_6"> </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"> Date of Birth </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q7_birthDate[month]" id="input_7_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_7_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q7_birthDate[day]" id="input_7_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_7_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q7_birthDate[year]" id="input_7_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_7_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_49"><div class="form-label-left" id="label_49"><label for="input_49"> Age </label><label class="label-message" for="input_49"> </label></div><div id="cid_49" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_49" name="q49_input49" size="6" value="" /> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Grade entering Sept 2026 </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_9" name="q9_input9" size="6" value="" /> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10">  </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio" 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value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_11_country" id="sublabel_11_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_52"><div class="form-label-left" id="label_52"><label for="input_52"> Enrollment<span class="form-required">*</span> </label><label class="label-message" for="input_52"> </label></div><div id="cid_52" 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_52_0" name="q52_input52[]" value="Session l: June 15-19" /><label id="label_input_52_0" for="input_52_0"><span>Session l: June 15-19</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_52_1" name="q52_input52[]" value="Session II:  June 22-26" /><label id="label_input_52_1" for="input_52_1"><span>Session II:  June 22-26</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_52_2" name="q52_input52[]" value="Full Session: Both weeks, June 15-26" /><label id="label_input_52_2" for="input_52_2"><span>Full Session: Both weeks, June 15-26</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_69"><div class="form-label-left" id="label_69"><label for="input_69"> Does your child have any friend preferences for their group? </label><label class="label-message" for="input_69"> we will try our best to accommodate if possible</label></div><div id="cid_69" class="form-input"> <textarea id="input_69" class="form-textarea" name="q69_input69" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_70"><div class="form-label-left" id="label_70"><label for="input_70"> Child's T-shirt size (at time of camp)<span class="form-required">*</span> </label><label class="label-message" for="input_70"> </label></div><div id="cid_70" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_70" name="q70_input70"><option value="">Choose One</option><option value="Youth XSMALL (4-6)">Youth XSMALL (4-6)</option><option value="Youth SMALL (6-8)">Youth SMALL (6-8)</option><option value="Youth MEDIUM (10-12)">Youth MEDIUM (10-12)</option><option value="Youth LARGE (14-16)">Youth LARGE (14-16)</option><option value="Youth XL (18-20)">Youth XL (18-20)</option><option value="Adult SMALL">Adult SMALL</option></select> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> ALLERGY INFORMATION: Please list any allergies that your child has or other health issues we should be aware of. List NONE of no allergies<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <textarea id="input_15" class="form-textarea validate[required]" name="q15_input15" cols="40" rows="6"></textarea> </div></li><li id="cid_45" class="form-input-wide"> <div class="form-header-group"><h2 id="header_45" class="form-header">Child 2:</h2></div> </li><li class="form-line" id="id_46"><div class="form-label-left" id="label_46"><label for="input_46"> Name of Child 2 </label><label class="label-message" for="input_46"> </label></div><div id="cid_46" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q46_fullName46[first]" id="first_46" autocomplete="given-name" />  <label class="form-sub-label" for="first_46" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q46_fullName46[last]" id="last_46" autocomplete="family-name" />  <label class="form-sub-label" for="last_46" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_47"><div class="form-label-left" id="label_47"><label for="input_47"> Name child 2 prefers to be called </label><label class="label-message" for="input_47"> </label></div><div id="cid_47" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_47" name="q47_input47" size="20" value="" /> </div></li><li class="form-line" id="id_63"><div class="form-label-left" id="label_63"><label for="input_63"> Date of Birth child 2 </label><label class="label-message" for="input_63"> </label></div><div id="cid_63" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q63_birthDate63[month]" id="input_63_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_63_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q63_birthDate63[day]" id="input_63_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_63_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q63_birthDate63[year]" id="input_63_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_63_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_62"><div class="form-label-left" id="label_62"><label for="input_62"> Age child 2 </label><label class="label-message" for="input_62"> </label></div><div id="cid_62" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_62" name="q62_input62" size="4" value="" /> </div></li><li class="form-line" id="id_50"><div class="form-label-left" id="label_50"><label for="input_50"> Grade entering Sept 2026 child 2 </label><label class="label-message" for="input_50"> </label></div><div id="cid_50" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_50" name="q50_input50" size="4" value="" /> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Enrollment- Child 2<span class="form-required">*</span> </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" 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_13_0" name="q13_input13[]" value="Session l: June 15-19" /><label id="label_input_13_0" for="input_13_0"><span>Session l: June 15-19</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_13_1" name="q13_input13[]" value="Session II: June 22-26" /><label id="label_input_13_1" for="input_13_1"><span>Session II: June 22-26</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_13_2" name="q13_input13[]" value="Full Session: Both weeks, June 15-26" /><label id="label_input_13_2" for="input_13_2"><span>Full Session: Both weeks, June 15-26</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_71"><div class="form-label-left" id="label_71"><label for="input_71"> Does your child have any friend preferences for their group? Child 2 </label><label class="label-message" for="input_71"> we will try our best to accommodate if possible</label></div><div id="cid_71" class="form-input"> <textarea id="input_71" class="form-textarea" name="q71_input71" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_72"><div class="form-label-left" id="label_72"><label for="input_72"> Child's T-shirt size (at time of camp) Child 2<span class="form-required">*</span> </label><label class="label-message" for="input_72"> </label></div><div id="cid_72" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_72" name="q72_input72"><option value="">Choose One</option><option value="Youth XSMALL (4-6)">Youth XSMALL (4-6)</option><option value="Youth SMALL (6-8)">Youth SMALL (6-8)</option><option value="Youth MEDIUM (10-12)">Youth MEDIUM (10-12)</option><option value="Youth LARGE (14-16)">Youth LARGE (14-16)</option><option value="Youth XL (18-20)">Youth XL (18-20)</option><option value="Adult SMALL">Adult SMALL</option></select> </div></li><li class="form-line" id="id_54"><div class="form-label-left" id="label_54"><label for="input_54"> ALLERGY INFORMATION Child 2: Please list any allergies that your child has or other health issues we should be aware of. List NONE of no allergies<span class="form-required">*</span> </label><label class="label-message" for="input_54"> </label></div><div id="cid_54" class="form-input"> <textarea id="input_54" class="form-textarea validate[required]" name="q54_input54" cols="40" rows="6"></textarea> </div></li><li id="cid_55" class="form-input-wide"> <div class="form-header-group"><h2 id="header_55" class="form-header">Child 3:</h2></div> </li><li class="form-line" id="id_56"><div class="form-label-left" id="label_56"><label for="input_56"> Name of Child 3 </label><label class="label-message" for="input_56"> </label></div><div id="cid_56" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q56_fullName56[first]" id="first_56" autocomplete="given-name" />  <label class="form-sub-label" for="first_56" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q56_fullName56[last]" id="last_56" autocomplete="family-name" />  <label class="form-sub-label" for="last_56" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_64"><div class="form-label-left" id="label_64"><label for="input_64"> Name child 3 prefers to be called </label><label class="label-message" for="input_64"> </label></div><div id="cid_64" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_64" name="q64_input64" size="20" value="" /> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Date of Birth child 3 </label><label class="label-message" for="input_48"> </label></div><div id="cid_48" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q48_birthDate48[month]" id="input_48_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_48_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q48_birthDate48[day]" id="input_48_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_48_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q48_birthDate48[year]" id="input_48_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_48_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Age child 3 </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_8" name="q8_input8" size="4" value="" /> </div></li><li class="form-line" id="id_61"><div class="form-label-left" id="label_61"><label for="input_61"> Grade entering Sept 2026 child 3 </label><label class="label-message" for="input_61"> </label></div><div id="cid_61" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_61" name="q61_input61" size="4" value="" /> </div></li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Enrollment child 3<span class="form-required">*</span> </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" 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_60_0" name="q60_input60[]" value="Session l: June 15-19" /><label id="label_input_60_0" for="input_60_0"><span>Session l: June 15-19</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_60_1" name="q60_input60[]" value="Session II: June 22-26" /><label id="label_input_60_1" for="input_60_1"><span>Session II: June 22-26</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_60_2" name="q60_input60[]" value="Full Session: Both weeks, June 15- 26" /><label id="label_input_60_2" for="input_60_2"><span>Full Session: Both weeks, June 15- 26</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_73"><div class="form-label-left" id="label_73"><label for="input_73"> Does your child have any friend preferences for their bunk? Child 3 </label><label class="label-message" for="input_73"> we will try our best to accommodate if possible</label></div><div id="cid_73" class="form-input"> <textarea id="input_73" class="form-textarea" name="q73_input73" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_74"><div class="form-label-left" id="label_74"><label for="input_74"> Child's T-shirt size (at time of camp) Child 3<span class="form-required">*</span> </label><label class="label-message" for="input_74"> </label></div><div id="cid_74" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_74" name="q74_input74"><option value="">Choose One</option><option value="Youth XSMALL (4-6)">Youth XSMALL (4-6)</option><option value="Youth SMALL (6-8)">Youth SMALL (6-8)</option><option value="Youth MEDIUM (10-12)">Youth MEDIUM (10-12)</option><option value="Youth LARGE (14-16)">Youth LARGE (14-16)</option><option value="Youth XL (18-20)">Youth XL (18-20)</option><option value="Adult SMALL">Adult SMALL</option></select> </div></li><li class="form-line" id="id_57"><div class="form-label-left" id="label_57"><label for="input_57"> ALLERGY INFORMATION 3: Please list any allergies that your child has or other health issues we should be aware of. List NONE of no allergies </label><label class="label-message" for="input_57"> </label></div><div id="cid_57" class="form-input"> <textarea id="input_57" class="form-textarea" name="q57_input57" cols="40" rows="6"></textarea> </div></li><li id="cid_16" class="form-input-wide"> <div class="form-header-group"><h2 id="header_16" class="form-header">EMERGENCY INFORMATION</h2></div> </li><li class="form-line" id="id_19"><div id="cid_19" class="form-input-wide"> <div id="text_19" class="form-html"><p><em>In case of an emergency, we will make every attempt possible to reach the parents first. If we are unable to reach the parents we will contact the emergency contact listed below.</em></p>
</div> </div></li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Emergency Contact 1:<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q17_fullName17[first]" id="first_17" autocomplete="given-name" />  <label class="form-sub-label" for="first_17" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q17_fullName17[last]" id="last_17" autocomplete="family-name" />  <label class="form-sub-label" for="last_17" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Emergency contact phone :<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q18_phoneNumber[area]" id="input_18_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_18_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q18_phoneNumber[phone]" id="input_18_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_18_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Emergency Contact 2: </label><label class="label-message" for="input_20"> optional</label></div><div id="cid_20" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q20_fullName20[first]" id="first_20" autocomplete="given-name" />  <label class="form-sub-label" for="first_20" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q20_fullName20[last]" id="last_20" autocomplete="family-name" />  <label class="form-sub-label" for="last_20" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> Emergency contact 2 phone : </label><label class="label-message" for="input_21"> optional</label></div><div id="cid_21" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox" type="tel" name="q21_phoneNumber21[area]" id="input_21_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_21_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox" type="tel" name="q21_phoneNumber21[phone]" id="input_21_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_21_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> Child's Doctor<span class="form-required">*</span> </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q22_fullName22[first]" id="first_22" autocomplete="given-name" />  <label class="form-sub-label" for="first_22" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q22_fullName22[last]" id="last_22" autocomplete="family-name" />  <label class="form-sub-label" for="last_22" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_23"><div class="form-label-left" id="label_23"><label for="input_23"> Doctor's Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_23"> </label></div><div id="cid_23" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q23_phoneNumber23[area]" id="input_23_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_23_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q23_phoneNumber23[phone]" id="input_23_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_23_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li id="cid_24" class="form-input-wide"> <div class="form-header-group"><h2 id="header_24" class="form-header">PARENT INFORMATION</h2></div> </li><li class="form-line" id="id_37"><div class="form-label-left" id="label_37"><label for="input_37"> Father's Name<span class="form-required">*</span> </label><label class="label-message" for="input_37"> write NA if not applicable</label></div><div id="cid_37" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q37_fullName37[first]" id="first_37" autocomplete="given-name" />  <label class="form-sub-label" for="first_37" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q37_fullName37[last]" id="last_37" autocomplete="family-name" />  <label class="form-sub-label" for="last_37" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_39"><div class="form-label-left" id="label_39"><label for="input_39"> Father's Cell<span class="form-required">*</span> </label><label class="label-message" for="input_39"> write NA if not applicable</label></div><div id="cid_39" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q39_phoneNumber39[area]" id="input_39_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_39_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q39_phoneNumber39[phone]" id="input_39_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_39_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_38"><div class="form-label-left" id="label_38"><label for="input_38"> Father's Email<span class="form-required">*</span> </label><label class="label-message" for="input_38"> write NA if not applicable</label></div><div id="cid_38" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_38" name="q38_email38" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_40"><div class="form-label-left" id="label_40"><label for="input_40"> Mother's Name<span class="form-required">*</span> </label><label class="label-message" for="input_40"> write NA if not applicable</label></div><div id="cid_40" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q40_fullName40[first]" id="first_40" autocomplete="given-name" />  <label class="form-sub-label" for="first_40" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q40_fullName40[last]" id="last_40" autocomplete="family-name" />  <label class="form-sub-label" for="last_40" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_41"><div class="form-label-left" id="label_41"><label for="input_41"> Mother's Cell<span class="form-required">*</span> </label><label class="label-message" for="input_41"> write NA if not applicable</label></div><div id="cid_41" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q41_phoneNumber41[area]" id="input_41_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_41_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="tel" name="q41_phoneNumber41[phone]" id="input_41_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_41_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_42"><div class="form-label-left" id="label_42"><label for="input_42"> Mother's E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_42"> write NA if not applicable</label></div><div id="cid_42" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_42" name="q42_email42" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_75"><div class="form-label-left" id="label_75"><label for="input_75"> Which is the preferred email for camp information <span class="form-required">*</span> </label><label class="label-message" for="input_75"> </label></div><div id="cid_75" 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_75_0" name="q75_input75[]" value="Father" /><label id="label_input_75_0" for="input_75_0"><span>Father</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_75_1" name="q75_input75[]" value="Mother" /><label id="label_input_75_1" for="input_75_1"><span>Mother</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_75_2" name="q75_input75[]" value="Both" /><label id="label_input_75_2" for="input_75_2"><span>Both</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[required, other]" name="q75_input75[other]" id="other_75" value="" /><span><input type="text" class="form-checkbox-other-input form-textbox form-checkbox validate[required, other]" name="q75_input75[other][text]" data-otherhint="other (list preferred email)" size="15" id="input_75" disabled="disabled" /></span><br /></span></div> </div></li><li id="cid_36" class="form-input-wide"> <div class="form-header-group"><h2 id="header_36" class="form-header">FEES , DISCOUNTS &amp; PAYMENT</h2></div> </li><li class="form-line" id="id_25"><div id="cid_25" class="form-input-wide"> <div id="text_25" class="form-html"><p><span style="font-size:14px;"><span style="font-family:Verdana,Geneva,sans-serif;"><span style="color:#e74c3c;"><strong>Each Weekly Session:</strong></span> $350    </span></span></p>

<p><span style="font-size:14px;"><span style="font-family:Verdana,Geneva,sans-serif;"><strong><span style="color:#e74c3c;">Sibling Discounts:</span> </strong>2nd Child: $332   3rd Child:$315 </span></span></p>

<p><span style="font-size:14px;"><span style="font-family:Verdana,Geneva,sans-serif;"> * <span style="color:#e74c3c;">Scholarships</span> available.<a href="http://www.ChabadMinneapolis.com/5751997"><u> click here</u> </a>to fill out scholarship form - <em>no one will be turned away due to inability to pay</em></span></span></p>
</div> </div></li><li class="form-line" id="id_76"><div id="cid_76" class="form-input-wide"> <div id="text_76" class="form-html"><p><span style="font-family:Verdana,Geneva,sans-serif;"><span style="color:#e74c3c;"><strong>SECURITY FEE:</strong></span> $25 per family, per week. This fee helps cover security costs and is included in the total camp tuition</span></p>
</div> </div></li><li class="form-line" id="id_26"><div id="cid_26" class="form-input-wide"> <div id="text_26" class="form-html"><p><em><span style="font-family:Verdana,Geneva,sans-serif;">$50 deposit per child is due at the time of registration and will be deducted from the tuition amount. Your child's registration is pending until deposit payment is received.</span></em></p>
</div> </div></li><li class="form-line" id="id_81"><div id="cid_81" class="form-input-wide"> <div id="text_81" class="form-html"><p><strong><font face="Verdana, Geneva, sans-serif"><i>The $50 Deposit will NOT be charged now. You will be contacted if a spot opens up and your deposit fee will be charged at that point.</i></font></strong></p>
</div> </div></li><li class="form-line" id="id_43"><div class="form-label-left" id="label_43"><label for="input_43"> $50 deposit per child due now<span class="form-required">*</span> </label><label class="label-message" for="input_43"> will be deducted from tuition amount</label></div><div id="cid_43" 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_43_0" name="q43_input43" value="1 child: $50" /><label id="label_input_43_0" for="input_43_0"><span>1 child: $50</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_43_1" name="q43_input43" value="2 Children: $100" /><label id="label_input_43_1" for="input_43_1"><span>2 Children: $100</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_43_2" name="q43_input43" value="3 Children: $150" /><label id="label_input_43_2" for="input_43_2"><span>3 Children: $150</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"> Payment </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <div class="form-error form-error--internal">⚠ You have not yet connected a credit card processor.</div><table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_27_creditCard" name="q27_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_27_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_27_other" name="q27_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_27_other">Check or other</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><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="q27_payment[cc_type]" id="input_27_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="q27_payment[cc_number]" id="input_27_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_27_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv hide"><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q27_payment[cc_ccv]" id="input_27_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_27_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="q27_payment[cc_nameOnCard]" id="input_27_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_27_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q27_payment[cc_exp_month]" id="input_27_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_27_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="q27_payment[cc_exp_year]" id="input_27_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_27_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2">Please mail to Chabad Minneapolis: 11033 Hillside Lane W., Minnetonka MN 55305</td></tr><tr class="billing_address hide"><th colspan="2">Billing Address</th></tr><tr class="billing_address hide"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q27_payment[addr_line1]" id="input_27_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_27_addr_line1" id="sublabel_27_addr_line1">Street Address</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q27_payment[city]" id="input_27_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_27_city" id="sublabel_27_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q27_payment[state]" id="input_27_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_27_state" id="sublabel_27_state">State / Province</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q27_payment[postal]" id="input_27_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_27_postal" id="sublabel_27_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q27_payment[country]" id="input_27_country" autocomplete="billing country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_27_country" id="sublabel_27_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_44"><div class="form-label-left" id="label_44"><label for="input_44"> Payment Arrangement:<span class="form-required">*</span> </label><label class="label-message" for="input_44"> </label></div><div id="cid_44" 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_44_0" name="q44_input44[]" value="Pay in full now" /><label id="label_input_44_0" for="input_44_0"><span>Pay in full now</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_44_1" name="q44_input44[]" value="Only $50 deposit now and the remainder one month from registration date" /><label id="label_input_44_1" for="input_44_1"><span>Only $50 deposit now and the remainder one month from registration date</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_44_2" name="q44_input44[]" value="Other: You will be contacted to arrange a payment plan" /><label id="label_input_44_2" for="input_44_2"><span>Other: You will be contacted to arrange a payment plan</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[required, other]" name="q44_input44[other]" id="other_44" value="" /><span><input type="text" class="form-checkbox-other-input form-textbox form-checkbox validate[required, other]" name="q44_input44[other][text]" data-otherhint="Comments:" size="15" id="input_44" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_77"><div class="form-label-left" id="label_77"><label for="input_77"> <span class="form-required">*</span> </label><label class="label-message" for="input_77"> </label></div><div id="cid_77" 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_77_0" name="q77_input77[]" value="As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Minneapolis/ Kosher Culinary Camp to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Minneapolis personnel will try, but are not required, to communicate with me prior to such treatment." /><label id="label_input_77_0" for="input_77_0"><span>As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Minneapolis/ Kosher Culinary Camp to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Minneapolis personnel will try, but are not required, to communicate with me prior to such treatment.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_30"><div class="form-label-left" id="label_30"><label for="input_30"> <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-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_30_0" name="q30_input30[]" value="I hereby give permission for my child to participate in all camp activities, join in outings if applicable on and beyond camp properties" /><label id="label_input_30_0" for="input_30_0"><span>I hereby give permission for my child to participate in all camp activities, join in outings if applicable on and beyond camp properties</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_78"><div class="form-label-left" id="label_78"><label for="input_78"> <span class="form-required">*</span> </label><label class="label-message" for="input_78"> </label></div><div id="cid_78" 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_78_0" name="q78_input78[]" value="I allow my child to be photographed while participating in camp activities and that these pictures may be used for marketing purposes" /><label id="label_input_78_0" for="input_78_0"><span>I allow my child to be photographed while participating in camp activities and that these pictures may be used for marketing purposes</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_79"><div class="form-label-left" id="label_79"><label for="input_79"> Name or Initials as Signature<span class="form-required">*</span> </label><label class="label-message" for="input_79"> </label></div><div id="cid_79" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_79" name="q79_input79" size="20" value="" /> </div></li><li class="form-line" id="id_34"><div class="form-label-left" id="label_34"><label for="input_34"> E-mail for confirmation<span class="form-required">*</span> </label><label class="label-message" for="input_34"> </label></div><div id="cid_34" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_34" name="q34_email34" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_80"><div class="form-label-left" id="label_80"><label for="input_80"> Comments: </label><label class="label-message" for="input_80"> </label></div><div id="cid_80" class="form-input"> <textarea id="input_80" class="form-textarea" name="q80_input80" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_32"><div class="form-label-left" id="label_32"><label for="input_32"> <span class="form-required">*</span> </label><label class="label-message" for="input_32"> </label></div><div id="cid_32" class="form-input"> <div class="datetime-fields"><div class="dir_ltr date-fields"><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox validate[required]" id="month_32" name="q32_input32[month]" type="tel" size="2" maxlength="2" value="01" />  <label class="form-sub-label" for="month_32" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox validate[required]" id="day_32" name="q32_input32[day]" type="tel" size="2" maxlength="2" value="10" />  <label class="form-sub-label" for="day_32" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox validate[required]" id="year_32" name="q32_input32[year]" type="tel" size="4" maxlength="4" value="2026" />  <label class="form-sub-label" for="year_32" id="sublabel_year">Year</label></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_32_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />  <label class="form-sub-label" for="input_32_pick"><span> </span></label></span></div><span class="dir_ltr inline_block time-fields" style="white-space: nowrap;"><span class="form-sub-label-container"><span id="at_32" class="form-control-static at-label">at</span>  <label class="form-sub-label" for="at_32"><span> </span></label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" id="hour_32" name="q32_input32[hour]"><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 selected="selected" value="10">10</option><option value="11">11</option><option value="12">12</option></select>  <label class="form-sub-label" for="hour_32" id="sublabel_hour">Hour</label></span><span class="form-sub-label-container"><select class="form-dropdown validate[required]" id="min_32" name="q32_input32[min]"><option></option><option value="00">00</option><option selected="selected" value="10">10</option><option value="20">20</option><option value="30">30</option><option value="40">40</option><option value="50">50</option></select>  <label class="form-sub-label" for="min_32" id="sublabel_minutes">Minutes</label></span><span class="form-sub-label-container"><select class="form-dropdown validate[required]" id="ampm_32" name="q32_input32[ampm]"><option value="AM">AM</option><option selected="selected" value="PM">PM</option></select>  <label class="form-sub-label" for="ampm_32"><span> </span></label></span></span></div> </div></li><li class="form-line" id="id_35"><div id="cid_35" class="form-input-wide"> <div id="text_35" class="form-html"><p style="text-align: center;"><span style="font-size:14px;"><span style="font-family:Verdana,Geneva,sans-serif;">We look forward to having your child / children!</span></span></p>

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