Camp Register Form

Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. CGI is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative activities, to both provide enjoyment and inspire children to try new and exciting things!
Choose Session
Code
Weeks Attending $360/week

Week 1: June 30 - July 4Week 2: July 7-11Week 3: July 14-18Week 4: July 21-25
EARLY BIRD Weeks Attending ($340/week)

Week 1: June 30 - July 4Week 2: July 7-11Week 3: July 14-18Week 4: July 21-25
Weeks Enrolling

Week 1: June 30 - July 4Week 2: July 7-11Week 3: July 14-18Week 4: July 21-25
Registration Fee* One time fee

$40
Total

$40.00
Optional Extended Care
Morning Care $35/Week

Week 1Week 2Week 3Week 4
After Care $50/week

Week 1Week 2Week 3Week 4
Camper Information
Camper's Name *
Camper's First Name Last Name
Hebrew Name
Gender*
Date of Birth*

Month Day Year

Address*

Home Phone*

Area Code Phone Number
School*
Grade Entering*
T-Shirt Size Preferred
Notes/Comments:
Medical Information
Physician Name
Physician Phone
Insurance
Insurance Number
Allergies
Does your child take regular medication? If yes, please specify.
Does your child have any medical conditions we should be aware of?
Medical Note
Parent Information
Mother
Mother's Name
Mother's First Mother's Last
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail*
Father
Father's Name
Father's First Father's Last
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail*
Marital Status
Were the natural mother and maternal grandmother of the child born Jewish?

YesNo
Have there been adoptions or conversions in the family?

YesNo
If yes, please explain:
Emergency Information
Emergency 1*
E1 First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Out of State Contact*
E2 First Name Last Name
Phone Number*

Area Code Phone Number
Relation
Payment and Submission

Payment Method

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Camp Gan Israel to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Camp Gan Israel personnel will try, but are not required, to communicate with me/us prior to such treatment.
*

I Agree to the terms and conditions above.
Parent/Guardian Name
Date
Comments
Should be Empty:

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