(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 CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* School Attending* Entering Grade* Camper 2 Information #2 Full Name* First Name Last Name #2 Hebrew Name* #2 Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 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 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year #3 Gender* #3 Attending School* #3 Entering Grade* Camper 4 Information #4 Full Name* First Name Last Name #4 Hebrew Name* #4 Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year #4 Gender* #4 Attending School* #4 Entering Grade* Camper 5 Information # 5 Full Name* First Name Last Name #5 Hebrew Name* #5 Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year #5 Gender* #5 Attending School* #5 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 InformationA 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 - $200Mini Gan Half Day Two Weeks - $400Mini Gan Half Day Full Session - $550Mini Gan Full Day One Week - $250Mini Gan Full Day Two Weeks - $500Mini Gan Full Day Full Session - $675Older Division One Week - $250Older Division Two Weeks - $500Older Division Full Session - $675CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 2 Camp Options* Mini Gan Half Day One Week - $200Mini Gan Half Day Two Weeks - $400Mini Gan Half Day Full Session - $550Mini Gan Full Day One Week - $250Mini Gan Full Day Two Weeks - $500Mini Gan Full Day Full Session - $675Older Division One Week - $250Older Division Two Weeks - $500Older Division Full Session - $675CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 3 Camp Options* Mini Gan Half Day One Week - $200Mini Gan Half Day Two Weeks - $400Mini Gan Half Day Full Session - $550Mini Gan Full Day One Week - $250Mini Gan Full Day Two Weeks - $500Mini Gan Full Day Full Session - $675Older Division One Week - $250Older Division Two Weeks - $500Older Division Full Session - $675CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 4 Camp Options* Mini Gan Half Day One Week - $200Mini Gan Half Day Two Weeks - $400Mini Gan Half Day Full Session - $550Mini Gan Full Day One Week - $250Mini Gan Full Day Two Weeks - $500Mini Gan Full Day Full Session - $675Older Division One Week - $250Older Division Two Weeks - $500Older Division Full Session - $675CITs One Week - $200CITs Two Weeks - $400CITs Three Weeks - $590 Child 5 Camp Options* Mini Gan Half Day One Week - $200Mini Gan Half Day Two Weeks - $400Mini Gan Half Day Full Session - $550Mini Gan Full Day One Week - $250Mini Gan Full Day Two Weeks - $500Mini Gan Full Day Full Session - $675Older Division One Week - $250Older Division Two Weeks - $500Older Division Full Session - $675CITs 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, July 1 - Friday, July 5Week 2: Monday, July 8 - Friday, July 12Week 3: Monday, July 15- Friday, July 19Full Session: July 1 - 19 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 SChild MChild LAdult SAdult MAdult L Child 2 T-shirt Size ($20/each) Child SChild MChild LAdult SAdult MAdult L Child 3 T-shirt Size ($20/each) Child SChild MChild LAdult SAdult MAdult L Child 4 T-shirt Size ($20/each) Child SChild MChild LAdult SAdult MAdult L Child 5 T-shirt Size ($20/each) Child SChild MChild LAdult SAdult MAdult 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 Child 4 Lunch selection: 1 Week2 Weeks3 Weeks Child 5 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 Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPaypal has been selected. Payment will take place on the next page.Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit 100% of the proceeds of this donation or payment benefit Chabad of The Woodlands. 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