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 Gender Gender Gender 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 Fees Full Week of Camp! $199 $30 off each additional child's camp fee $99 for Counselors-in-Training (12+) After Care Program (3:30pm - 5:00pm) (available for an additional fee upon request) Monday Tuesday Wednesday Thursday Friday T-shirt. Campers are required to wear a CGI t-shirt every day. $10 a T-shirt Child 0 1 2 3 4 5 6 7 8 9 10 Small 0 1 2 3 4 5 6 7 8 9 10 Medium 0 1 2 3 4 5 6 7 8 9 10 Large Adult 0 1 2 3 4 5 6 7 8 9 10 Small 0 1 2 3 4 5 6 7 8 9 10 Medium 0 1 2 3 4 5 6 7 8 9 10 Large Parents' Information Parents' Status Married Widowed Divorced Seperated Home phone Home Address City State Zip Father's full name work phone cell phone email Mother's full name work phone cell phone email Comments Emergency Contact Information Contact 1 Phone Relationship to child Contact 2 Phone Relationship to child Family Physician Phone Are there any medical concerns that your child's counselor should be aware of? Permission 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 meaures 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/Gaurdian 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 July 6. Last Name Total charge amount First Name Card Type Please Select Visa American Express Discover Mastercard Address Card Number City Exp. Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 State CVV code 3 digits on back of card Zip Comments This page uses 128 bit SSL encryption to keep your data secure.
