(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 Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Mother's Full Name* First Name Last Name Mother's Cell Number* Area Code Phone Number Mother's E-mail* Father's Full Name* First Name Last Name Father's Cell Number* Area Code Phone Number Father's E-mail* Is the Child(ren)'s Mother Jewish?* YesNo Have there been any conversions or adoptions in the family?* YesNo If yes, please elaborate Number of Children being registered ($50 registration fee per child)* Camper 1 Information Full Name* First Name Last Name Hebrew Name Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* School Attending* Entering Grade* Camper 2 Information #2 Full Name First Name Last Name #2 Hebrew Name #2 Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year #2 Gender #2 School Attending #2 Entering Grade Camper 3 Information #3 Full Name First Name Last Name #3 Hebrew Name #3 Birth Date 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year #3 Gender #3 Attending School #3 Entering Grade 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. Tuition Information A sibling refund of 10% per child, will be applied to the highest tuition per family. Child 1 Camp Options* Mini Gan Half Day One Week - $250Mini Gan Half Day Two Weeks - $500Mini Gan Half Day Full Session - $650Mini Gan Full Day One Week - $300Mini Gan Full Day Two Weeks - $600Mini Gan Full Day Full Session - $775Older Division One Week - $300Older Division Two Weeks - $600Older Division Full Session - $775CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 2 Camp Options Mini Gan Half Day One Week - $250Mini Gan Half Day Two Weeks - $500Mini Gan Half Day Full Session - $650Mini Gan Full Day One Week - $300Mini Gan Full Day Two Weeks - $600Mini Gan Full Day Full Session - $775Older Division One Week - $300Older Division Two Weeks - $600Older Division Full Session - $775CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 3 Camp Options Mini Gan Half Day One Week - $250Mini Gan Half Day Two Weeks - $500Mini Gan Half Day Full Session - $650Mini Gan Full Day One Week - $300Mini Gan Full Day Two Weeks - $600Mini Gan Full Day Full Session - $775Older Division One Week - $300Older Division Two Weeks - $600Older Division Full Session - $775CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 2 Camp Options Mini Gan Half Day One Week - $225Mini Gan Half Day Two Weeks - $450Mini Gan Half Day Full Session - $600Mini Gan Full Day One Week - $275Mini Gan Full Day Two Weeks - $550Mini Gan Full Day Full Session - $725Older Division One Week - $275Older Division Two Weeks - $550Older Division Full Session - $675CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 3 Camp Options Mini Gan Half Day One Week - $225Mini Gan Half Day Two Weeks - $450Mini Gan Half Day Full Session - $600Mini Gan Full Day One Week - $275Mini Gan Full Day Two Weeks - $550Mini Gan Full Day Full Session - $725Older Division One Week - $275Older Division Two Weeks - $550Older Division Full Session - $725CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 3 Camp Options Mini Gan Half Day One Week - $225Mini Gan Half Day Two Weeks - $450Mini Gan Half Day Full Session - $495Mini Gan Full Day One Week - $275Mini Gan Full Day Two Weeks - $550Mini Gan Full Day Full Session - $595Older Division One Week - $275Older Division Two Weeks - $550Older Division Full Session - $595CITs One Week - $275CITs Two Weeks - $550CITs Three Weeks - $595 Child 2 Camp Options Mini Gan Half Day - $175/week, $450 for entire sessionMini Gan Full Day - $225/week, $595 for entire sessionOlder Division - $225/week, $595 for entire sessionCITs - $150/week Child 3 Camp Options Mini Gan Half Day - $175/week, $450 for entire sessionMini Gan Full Day - $225/week, $595 for entire sessionOlder Division - $225/week, $595 for entire sessionCITs - $150/week My child(ren) will be attending:* Week 1: Monday, June 26- Friday, June 30Week 2: Monday, July 3 - Friday, July 7Week 3: Monday, July 10- Friday, July 14Full Session: June 26 - July 14 Child 1 T-shirt Size ($20/each) Child S Child M Child L Adult S Adult M Adult L Child 2 T-shirt Size ($20/each) Child S Child M Child L Adult S Adult M Adult L Child 3 T-shirt Size ($20/each) Child S Child M Child L Adult S Adult M Adult L I would like for CGI to provide lunch ($30/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 Questions / Comments $36 Registration per Child is due upon Registration. Please indicate when you would like the balance charged. I would love to share the Jewish camp experience with another family, by contributing to the Camp Scholarship Fund! $ Total $0.00 I would like to pay today:Full amount$100.00 minimum$ Payment Balance may be paid by check Credit Card Paypal Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Paypal has been selected. Payment will take place on the next page. Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country How did you hear about us? Submit 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.