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Register

Register

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

Family Information
Address
  Street
City
State
Zip
Contact Info
  Phone
Email
 
Child's Mother
  Mother's Name
Hebrew Name
Work Phone Cell
Child's Father
  Father's Name
Hebrew Name
Work Phone Cell
Emergency Contact Info
  Name
Phone
Relationship  
Pediatrician
  Name
Phone
   
Camper 1 Information
Name
  First
Middle
Last
Date of Birth
 
Schools
  School
Hebrew School
Entering Grade:
Select Division Camper 1
C.I.T. (Girls 13-15)
Grand Gan (5-9)
Pioneers (10-12)
Arts & Nature (3-4)
Arts & Nature - Half Day (3-4)    
Select Sessions Camper 1
Session 1: June 26 - June 30
Session 4: July 17 - 21
Session 2: July 3 - 7 (No camp July 4th)
Session 5: July 24 - 28
Session 3: July 10 - 14
Session 6: July 31 - August 4 (No Camp Aug. 1)
Camper 2 Information
Name
  First
Middle
Last
Date of Birth
 
Schools
  School
Hebrew School
Entering Grade:
Select Division Camper 2
C.I.T. (Girls 13-15)
Grand Gan (5-9)
Pioneers (10-12)
Arts & Nature (3-4)
Arts & Nature - Half Day (3-4)    
Select Sessions Camper 2
Session 1: June 26 - June 30
Session 4: July 17 - 21
Session 2: July 3 - 7 (No camp July 4th)
Session 5: July 24 - 28
Session 3: July 10 - 14
Session 6: July 31 - August 4 (No Camp Aug. 1)
Camper 3 Information
Name
  First
Middle
Last
Date of Birth
 
Schools
  School
Hebrew School
Entering Grade:
Select Division Camper 3
C.I.T. (Girls 13-15)
Grand Gan (5-9)
Pioneers (10-12)
Arts & Nature (3-4)
Arts & Nature - Half Day (3-4)    
Select Sessions Camper 3
Session 1: June 26 - June 30
Session 4: July 17 - 21
Session 2: July 3 - 7 (No camp July 4th)
Session 5: July 24 - 28
Session 3: July 10 - 14
Session 6: July 31 - August 4 (No Camp Aug. 1)
Extended Care | $8 per session
AM Session: 8:00 - 9:00 pm
PM Session: 3:45 - 5:00 pm
Days Needed |
Payment
Payment Method Total Amount to Charge $
Name on Card Card Number
Expiration CVV Code
Terms and Agreement
  Medical forms must be completed by physician and returned before your child begins camp.
Non-refundable fee of $50 accompanies application. One free T-shirt included. Size:
I have read the camp application form and agree to the terms stated.
I give my child permission to attend all trips, and receive medical care in case of emergency. I give Camp Gan Israel permission to take photographs of my child during camp activities. These photographs may be used in future publications related to camp.
   
  Date of Application:

 

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