Registration

(Scholarship applicants must also complete the Scholarship Application )
Number of Children being registered*
Camper 1 Information
Full Name*
First NameLast Name
Hebrew Name
Birth Date*
MonthDayYear
Gender*
School Attending*
Entering Grade*
Camper 2 Information
#2 Full Name
First NameLast Name
#2 Hebrew Name
#2 Birth Date
MonthDayYear
#2 Gender
#2 School Attending
#2 Entering Grade
Camper 3 Information
#3 Full Name
First NameLast Name
#3 Hebrew Name
#3 Birth Date
MonthDayYear
#3 Gender
#3 Attending School
#3 Entering Grade
Parent's Information
Parent's Status*
MarriedWidowedDivorcedSeparated
Home Phone*
Area CodePhone Number

Home Address*

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

Father's Full Name*
First NameLast Name
Father's Cell Number*
Area CodePhone Number
Father's E-mail*
Mother's Full Name*
First NameLast Name
Mother's Cell Number*
Area CodePhone Number
Mother'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
Emergency Contact Information
Contact 1 Full Name*
First NameLast Name
Contact 1 Phone Number*
Area CodePhone Number
Contact 1 Relationship to Child*
Contact 2 Full Name
First NameLast Name
Contact 2 Phone Number
Area CodePhone Number
Contact 2 Relationship to Child
Family Physician*
Physician Phone Number*
Area CodePhone Number
Are there any medical concerns that our staff should be aware of?*
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
Child 1 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 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:*
June 21 - June 25June 28 - July 2July 5 - July 9Full Session: June 21 - July 9
Child 1 T-shirt Size ($15/each)
Child 2 T-shirt Size ($15/each)
Child 3 T-shirt Size ($15/each)
$36 Registration per Child is due upon Registration. Please indicate when you would like the balance charged.*
Amount to be charged today (in addition to required registration fee)
$
Total
$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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Camper 1 Information

Camper 2 Information

Camper 3 Information

Parent's Information

Emergency Contact Information

General Information

Tuition Information