Registration - Chabad of The Woodlands

(Scholarship applicants must also complete the Scholarship Application)
Parent's Information
Parent's Status*

MarriedWidowedDivorcedSeparated
Home Phone*

Area Code Phone Number

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Full Name*
First Name Last Name
Mother's Cell Number*

Area Code Phone Number
Mother's E-mail*
Mother's Employer
Position
Father's Full Name*
First Name Last Name
Father's Cell Number*

Area Code Phone Number
Father's E-mail*
Father's Employer
Position
Is the Child(ren)'s Mother Jewish?*

YesNo
Have there been any conversions or adoptions in the family?*

YesNo
If yes, please elaborate
I am referring / I was referred by: Both families get a $150 credit for a successful Referral
Which tier would you like to pay?*

Tier I (Actual Cost)Tier II (Partially Subsidized)Tier III (Substantially Subsidized)
I need additional assistance, and will request a Scholarship.
Number of Children being registered ($50 registration fee per child)*
Camper 1 Information
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Gender*
School Attending*
Entering Grade*
Division:*

Mini Gan Half Day: ages 2-4Mini Gan Full Day: ages 2-4Main Camp: girls ages 5-11, boys ages 5-8Older boys: ages 9-11Counselors In Training (CIT): girls ages 12-13
CIT:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Camper 2 Information
#2 Full Name*
First Name Last Name
#2 Hebrew Name*
#2 Birth Date*

Month Day Year
#2 Gender*
#2 School Attending*
#2 Entering Grade*
Division:*

Mini Gan Half Day: ages 2-4Mini Gan Full Day: ages 2-4Main Camp: girls ages 5-11, boys ages 5-8Older boys: ages 9-11Counselors In Training (CIT): girls ages 12-13
CIT:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Camper 3 Information
#3 Full Name*
First Name Last Name
#3 Hebrew Name*
#3 Birth Date*

Month Day Year
#3 Gender*
#3 Attending School*
#3 Entering Grade*
Division:*

Mini Gan Half Day: ages 2-4Mini Gan Full Day: ages 2-4Main Camp: girls ages 5-11, boys ages 5-8Older boys: ages 9-11Counselors In Training (CIT): girls ages 12-13
CIT:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Camper 4 Information
#4 Full Name*
First Name Last Name
#4 Hebrew Name*
#4 Birth Date*

Month Day Year
#4 Gender*
#4 Attending School*
#4 Entering Grade*
Division:*

Mini Gan Half Day: ages 2-4Mini Gan Full Day: ages 2-4Main Camp: girls ages 5-11, boys ages 5-8Older boys: ages 9-11Counselors In Training (CIT): girls ages 12-13
CIT:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Camper 5 Information
# 5 Full Name*
First Name Last Name
#5 Hebrew Name*
#5 Birth Date*

Month Day Year
#5 Gender*
#5 Attending School*
#5 Entering Grade*
Division:*

Mini Gan Half Day: ages 2-4Mini Gan Full Day: ages 2-4Main Camp: girls ages 5-11, boys ages 5-8Older boys: ages 9-11Counselors In Training (CIT): girls ages 12-13
CIT:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier I:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier II:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full Summer - Half DayWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Tier III:*

Full SummerWeek 1: Monday, June 29 - Thursday, July 2Week 2: Monday, July 6 - Friday, July 10Week 3: Monday, July 13 - Friday, July 17
Emergency Contact Information
Contact 1 Full Name*
First Name Contact1 Last Name Contact1
Contact 1 Phone Number*

Area Code Phone Number
Contact 1 Relationship to Child*
Relationship1
Contact 2 Full Name
First Name Conatct2 Last Name Contact2
Contact 2 Phone Number

Area Code Phone Number
Contact 2 Relationship to Child
Relationship2
Family Physician*
Doctor
Physician Phone Number*

Area Code Phone Number
Are there any medical concerns that our staff should be aware of?*
Medical
General Information
Previous Camp(s) 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*
Briefly describe your child/ren's favorite activities*
Permissions*

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 measures 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/s named on this application as needed, for educational and public relations programs.I further release and agree to indemnify and hold harmless Camp Gan Israel and its officers, servants or assigns from any liability or claim for any loss, injury, damage or expense resulting or arising from my child’s participation in camp activities. I further agree that the use of any premises during the CGI camp day is made at the risk of the registrant.I acknowledge that the camp administration reserves the right to reconsider the enrollment of any camper if we feel the child’s needs or level of functioning or behavior cannot be accommodated, or if the child’s conduct limits his or her ability to participate in, or to benefit fully from, the program and activities at Camp Gan Israel.
Camp T-shirts are needed for trips. Do you need one?
(Late registrants may miss the batch order, and will be reimbursed if we can't accommodate)
Child 1 T-shirt Size ($20/each)
Child 2 T-shirt Size ($20/each)
Child 3 T-shirt Size ($20/each)
Child 4 T-shirt Size ($20/each)
Child 5 T-shirt Size ($20/each)
I would like for CGI to provide lunch ($35/week):
Child 1 Lunch selection:

1 Week2 Weeks3 Weeks
Child 2 Lunch selection:

1 Week2 Weeks3 Weeks
Child 3 Lunch selection:

1 Week2 Weeks3 Weeks
Child 4 Lunch selection:

1 Week2 Weeks3 Weeks
Child 5 Lunch selection:

1 Week2 Weeks3 Weeks
Questions / Comments
I would love to share the Jewish camp experience with another family, by contributing to the Camp Scholarship Fund!

$
Payment
A sibling refund of 10% per child, will be applied to the highest tuition per family.
Total

$0.00

I would like to pay today:Full amount$100.00 minimum$
I would like to pay the balance via monthly charges:

Please charge my card April - JunePlease charge my card April - July

Payment Method Balance may be paid by check

Credit Card Paypal

Postal / Zip Code

Country

100% of the proceeds of this donation or payment benefit Chabad of The Woodlands.
Should be Empty:

This page uses TLS encryption to keep your data secure.

Parent's Information

Camper 1 Information

Camper 2 Information

Camper 3 Information

Camper 4 Information

Camper 5 Information

Emergency Contact Information

General Information

Camp T-shirts are needed for trips. Do you need one?

I would like for CGI to provide lunch ($35/week):

Payment