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  Small  Medium  Large
Adult  Small  Medium  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
Address   Card Number
City   Exp. Date  
State   CVV code  3 digits on back of card
Zip   Comments