Register

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Parent #1 Name*

First Name Last Name

Parent #1 E-mail*

Parent #1 Mobile*

Area Code Phone Number

Parent #2 Name

First Name Last Name

Parent #2 E-mail

Parent #2 Mobile

Area Code Phone Number

Home Address*

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

Is the mother of the child Jewish?*

YesNo

Is the father of the child Jewish?*

YesNo

Was there any conversions or adoptions in the family?*

YesNo

If yes, please describe:

Current Date

Month Day Year

Number of Children You Are Registering* Ages 5-12

$350 per child

We are signing up for*

Full Session (all three weeks)One weekTwo weeks

Please choose*

Week 1 (July 20-24)Week 2 (July 27-31)Week 3 (August 3-7)

Please choose* $350/child per week

Week 1 (July 20-24)Week 2 (July 27-31)Week 3 (August 3-7)

Child #1 Name*

First Name Last Name

Child #1 Hebrew Name*

Child #1 Birth Date*

Month Day Year

Child #1 Age*

Does your child have any allergies?*

NoYes

Child #1 Allergies*

Is your child presently taking any medication?*

NoYes

Child #1 Medications*

Is there any other medical info or concerns we should know about your child?*

NoYes

Child #1 Medical Info*

Child #2 Name*

First Name Last Name

Child #2 Hebrew Name*

Child #2 Birth Date*

Month Day Year

Child #2 Age*

Does your child have any allergies?*

NoYes

Child #2 Allergies*

Is your child presently taking any medication?*

NoYes

Child #2 Medications*

Is there any other medical info or concerns we should know about your child?*

NoYes

Child #2 Medical Info*

Child #3 Name*

First Name Last Name

Child #3 Hebrew Name*

Child #3 Birth Date*

Month Day Year

Child #3 Age*

Does your child have any allergies?*

NoYes

Child #3 Allergies*

Is your child presently taking any medication?*

NoYes

Child #3 Medications*

Is there any other medical info or concerns we should know about your child?*

NoYes

Child #3 Medical Info*

Child #4 Name*

First Name Last Name

Child #4 Hebrew Name*

Child #4 Birth Date*

Month Day Year

Child #4 Age*

Does your child have any allergies?*

NoYes

Child #4 Allergies*

Is your child presently taking any medication?*

NoYes

Child #4 Medications*

Is there any other medical info or concerns we should know about your child?*

NoYes

Child #4 Medical Info*

Child #5 Name*

First Name Last Name

Child #5 Hebrew Name*

Child #5 Birth Date*

Month Day Year

Child #5 Age*

Does your child have any allergies?*

NoYes

Child #5 Allergies*

Is your child presently taking any medication?*

NoYes

Child #5 Medications*

Is there any other medical info or concerns we should know about your child?*

NoYes

Child #5 Medical Info*

To provide your child(ren) the best camp experience, please share any other info we should know.* Examples: Tips or tools that work best for your child, possible challenges - behavioral, emotional, or physical. We are here to help.

Emergency Contact*

First Name Last Name

Relationship to child(ren)*

Emergency Phone #*

Area Code Phone Number

Child{ren)'s Pediatrician

First Name Last Name

Name of Practice

Pediatrician's Phone

Area Code Phone Number

Promo Code:

Payment Options* $900 tuition each child

Payment Options* $350 tuition each child

Payment Options 5% off!

Deposit only - $50 per child1 Child - $855 (discounted from $1050)2 Children - $1710 (discounted from $1800)3 Children - $2565 (discounted from $2700)4 Children - $3420 (discounted from $3600)5 Children - $4275 (discounted from $4500)

Donate to our scholarship fund

$50$75$100

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Other

Postal / Zip Code

Country

A. The camper and parents agree to abide by the rules and regulations set by the camp for the health, safety, and welfare of the campers.

B. The camp is not responsible for articles of clothing, or personal belongings lost or damaged.

C. The camp will make every effort to protect the health and safety of every camper. However, it will not be responsible for the injury or health impairment of any camper. Therefore, it is understood that Camp Gan Israel cannot assume responsibility for accidents or losses, as a non-profit organization, and Camp Gan Israel is released from any liability for injury or loss to any child.

D. In case of emergency, doctors and hospitals may refuse to treat a minor unless the expressed prior consent of a parent or legal guardian has been obtained. Because of the possibility of being unable to reach a parent in an emergency, we request your permission (as indicated by your signature below) to exercise our best judgment in this matter, but without liability for such a determination.

E. No refund shall be given in the instance where a camper starts later than the agreed upon date of commencement or misses a regularly scheduled camped day. No refund shall be made in the instance where a camper terminated attendance earlier than the agreed upon date, unless it is in the Camp Director’s judgment that such earlier termination is necessary due to illness or other cause. In such an event a refund may be made not exceeding 50% camp fees. If however, a change is necessary as a result of Covid-19 related issues, a full refund may be given.

Confirmation*

I have read and agree to the above-stated terms. I hereby give my child permission to participate in Camp Gan Israel including field trips (and modes of conveyance determined by the camp), activities, and the receiving of any medical care in the case of emergency. I also give permission for my child/ren to be photographed and their picture used for marketing. The above releases from liability also apply here, as well.

Signature* Typing your full name is the equivalent of providing your signature

I would like to receive news and updates by email

Household Info

Child(ren) Info

Emergency Info

Pediatrician Info

Tuition Total

Terms and Conditions