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. JulyWeek 2: 15.-19. JulyWeek 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. JulyWeek 2: 15.-19. JulyWeek 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. JulyWeek 2: 15.-19. JulyWeek 1 + 2 2. Parent information Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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? MailerEmailFacebookNewspaper AdInternet SearchAttended PreviouslyOther 3. Emergency Information Emergency Contact* First Name Last Name Relationship to child* Phone Number* Area Code Phone Number 4. Payment InformationCHF 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 DetailsBasler Kantonalbank, CH-Basel SWIFT-BIC: BKBBCHBB IBAN: CH25 0077 0254 2231 5200 2In 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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