Register Online

Please fill out the form below:

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

Full session of boys Day Camp June 28 - July 16 - $375 (after $150 credit)

 Full session of BOYS overnight camp June 28 - July 16 - $770 (after $150 credit)
 Full session of GIRLS overnight camp July 29- August 5 - $270 (after $150 credit)
Camp T-Shirt $15
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
Emergency Contact Information
Contact 1
Relationship to child
Contact 2
Relationship to child
Family Physician
Are there any medical concerns that your child's counselor 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 to the administration of Camp Gan Israel to take whatever medical 
     measures they deem necessary for my child, in the event of a medical emergency
I also authorize Camp Gan Israel to have and use photographs, slides and videos of the person 
     named on this application as needed for educational and public relations programs
Parent/Guardian    Date

Payment Details
Registration is confirmed with minimum of $50 deposit per child.
Please indicate when you would like us to charge the additional amount.
Payment is needed in full before camp.
Last Name   Total charge amount
First Name   Card Type
Address   Card Number
City   Exp. Date  
State   CVV code  3 digits on back of card
Zip   Comments  


First-camper incentives and partial scholarship assistance is provided by the Russian-speaking Jewish Community of SF Bay Area and EZRA USA

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