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

Mini Gan Izzy: Half-day 
(Ages 3 -4)

$175  July 8 - July 12
$175 July 15 - July 19 
$175 July 22 - July 26
$450 July 8 - July 26

Mini Gan Izzy: Full-day
(Ages 3 -4)

$225 July 8 - July 12
$225 July 15 - July 19 
$225 July 22 - July 26
$595 July 8 - July 26

Older division
(Ages 5 -11)

$225 July 8 - July 12
$225 July 15 - July 19 
$225 July 22 - July 26
$595 July 8 - July 26


CIT program

$150 July 8 - July 12
$150 July 15 - July 19 
$150 July 22 - July 26  

I would like camp to provide lunch for $25/week
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
Is the children's mother Jewish?
Yes  No

Have there been any conversions or adoptions in the family?
Yes No
If yes, please elaborate.


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 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 July 1.
  • A sibling discount of 10%/child will be applied to the highest full-session tuition. 
Last Name  

Lunch fees 

Tuition fees

Registration fees


Total Charge

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