Camper Information
Camper 1 Camper 2 Camper 3
Campers Full Name Campers Full Name
Campers Full Name
Hebrew Name
Hebrew Name
Hebrew Name
Date of Birth
Date of Birth
Date of Birth
Gender
Gender
Gender
School Attending School Attending
School Attending
Entering Grade Entering Grade
Entering Grade
           
General Information
Previous Camps Attended
How did you hear about Camp Gan Israel?
What goals would you like to see your child/ren accomplish during camp?
Briefly describe your child/ren's personality

Child/ren's favorite activities
 

Fees



Monday, Dec. 21 Tuesday, Dec. 22Wednesday, Dec. 23

Thursday, Dec. 24Friday, Dec. 25

 
Monday Tuesday Wednesday Thursday Friday
 
 


 


Parents' Information
Parents' Status: Married Widowed Divorced Separated
Home phone
Home Address
City
State
Zip
Father's full name
work phone
cell phone
email
Mother's full name
work phone
cell phone
email
Comments
         
Emergency Contact Information
Contact 1
Phone
Relationship to child
 
Contact 2
Phone
Relationship to child
 
Family Physician
Phone
   
Are there any medical concerns that your child's counselor should be aware of?
 
Permission
I hereby give permission for my child to participate in all Camp Gan Israel activities and trips
I also hereby consent that the administration of Camp Gan Israel may take whatever medical meaures they deem necessary for my child, in the event of an emergency.
I also authorize Camp Gan Israel to have and use photographs, slides and videos of the person named on this application as needed, for educational and public relations programs.
Parent/Guardian Date


Payment Details
Registration is confirmed with minimum of $50 deposit per child.
Please indicate when you would like us to charge the additional amount.
Payment is needed in full by December 18.
Last Name  

Tuition fees:
Total Charge



First Name   Card Type
Address   Card Number
City   Exp. Date
State   CVV code 3 digits on back of card
Zip   Comments
 

100% of the proceeds of this donation or payment benefit Chabad of The Woodlands.