1. Child/ren’s Information Child 1* First Name Last Name Age as of 8.7.24* Gender* MaleFemale Is the child's mother Jewish?* Yes Does he/she suffer from any allergies or take any medication? Please specify if yes.* For which week/s are you registering child 1 Week 1: 8.-12. July Week 2: 15.-19. July Week 1 + 2 Child 2 First Name Last Name Age as of 8.7.24* Gender* MaleFemale Is the child's mother Jewish?* Yes Does he/she suffer from any allergies or take any medication? Please specify if yes.* For which week/s are you registering child 2 Week 1: 8.-12. July Week 2: 15.-19. July Week 1 + 2 Child 3 First Name Last Name Age as of 8.7.24* Gender* MaleFemale Is the child's mother Jewish?* Yes Does he/she suffer from any allergies or take any medication? Please specify if yes.* For which week/s are you registering child 3 Week 1: 8.-12. July Week 2: 15.-19. July Week 1 + 2 2. Parent information Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country E-mail* Primary email Mother's Cell Phone* Area Code Phone Number Father's Cell Phone Area Code Phone Number How did you hear of us? Mailer Email Facebook Newspaper Ad Internet Search Attended Previously Other 3. Emergency Information Emergency Contact* First Name Last Name Relationship to child* Phone Number* Area Code Phone Number 4. Payment Information CHF 190.- per child, per week *early bird discount CHF 170.- until 8th of May. Preferred Payment Method* Bank TransferCash PLEASE NOTE: Registration is complete upon receipt of payment. Bank Transfer Details Basler Kantonalbank, CH-Basel SWIFT-BIC: BKBBCHBB IBAN: CH25 0077 0254 2231 5200 2 In favor of: Mordechai Gruzman Herrengrabenweg 20, 4054 Basel Photos I allow photos of my child/ren to be posted on the parents whatsapp group.I allow photos of my child/ren to be posted on social media.I do not allow my child/ren to be photographed at all. General comments Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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