Register Online! | Camp Gan Israel

Online Registration!

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

Note: Please use a separate form for each child.

Camper/Parent Information
Name		First	Middle	Last
Address		Street	City	State	Zip
Date of Birth
Contact Info		Phone	Email
Schools		School	Hebrew School	Last Grade Completed
Child's Father		Father's Name	Hebrew Name	Work Phone	Cell
Child's Mother		Mother's Name	Hebrew Name	Work Phone	Cell
Emergency Contact Info		Name	Phone	Relationship
Pediatrician		Name	Phone
Email

Specify Your Child's Orientation
	Sports			Creative Arts
	Swimming			Music
	Other
Please indicate number of sessions your child will attend camp:


IMPORTANT
•	A $140 non-refundable deposit must be received to reserve a space for your son
•	All forms must be completed and submitted before your child begins camp.
•	I will be paying my deposit of $140 per child by: Check Cash
	I have read the camp brochure and application form and agree to the terms stated. I hereby accept responsibilty to pay the camp fee in full. I give my child permission to attend all trips, and receive medical care in the case of an emergency.
	Please note any special requests or concerns
	Date of Application: