Camper Information (Scholarship applicants must also complete the Scholarship Application)
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
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 (After March 31, fees for Older Division will rise to: $250/week, $595 for entire session)



Mini Gan Izzy
(Ages 3 -4)

$160. June 25 - June 29
$160. July 2 - July 6 
$160. July 9 - July 13
$400. June 25 - July 13

 $40/day - Daily Rate. Please list the dates in the comments section below.

Older division
(Ages 5 -11)

$220. June 25 - June 29 
$220. July 2 - July 6 
$220. July 9 - July 13 
$500. June 25 - July 13

CIT program

$75. June 25 - June 29 
$75. July 2 - July 6 
$75. July 9 - July 13  

After Care Program (3:00 pm - 4:30 pm) (available for an additional $9 daily fee)
Monday Tuesday Wednesday Thursday Friday
T-shirt. Campers are required to have a CGI t-shirt. The cost is $15 /shirt.
Child Small Medium Large
Adult Small Medium Large
Parents' Information
Parents' Status: Married Widowed Divorced Separated
Home phone
Home Address
Father's full name
work phone
cell phone
Mother's full name
work phone
cell phone
Emergency Contact Information
Contact 1
Relationship to child
Contact 2
Relationship to child
Family Physician
Are there any medical concerns that our staff  should be aware of?
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.
Parent/Guardian Date

Payment Details

  • Must be accompanied by a non-refundable $36 Registration fee (besides for t-shirt and tuition).
  • Registration (and early discount) is confirmed with a minimum of $36 deposit per child. Please indicate when you would like us to charge the additional amount.
  • Payment is needed in full by June 2.
Last Name  

Tuition fees

Registration fees


Total Charge

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