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Online Registration

Online Registration

Camper/Parent Information
Camper
Name
First Name
Last Name
Grade fall 2017
Male
Female
Address
Street
City
State
Zip
Date of Birth

Age

General Info
Home Phone
Synagogue Affiliation

Parent camper resides with
Both Father Mother
Camper's Father
Father's Name

Email

Work Phone
Cell
Camper's Mother
Mother's Name

Email

Work Phone
Cell
School Attending:
School Name
School Address
School Phone
 
 
Emergency Contact (other than parents) & Health Record
Emergency Contact
Name
Phone
Address
 
Emergency Contact
Name
Phone
Address
 
Pediatrician
Name
Phone
   
 

Please list any special needs (physical, developmental, learning, emotional, behavioral) that may require special awareness on the part of the camp staff:

 
         
Please indicate the weeks your child will attend camp

All ages:

Full Season 1st wk (6/26) 2nd wk (7/3) 3rd wk (7/10) 4th wk (7/17)
5th wk (7/24) 6th wk (7/31)

Extended Hours

Early Drop-off
Late Stay

T-Shirt Size
(runs small):

Youth - Small (6/8) Medium (10/12) Large (14/16)
Adult - Small Medium Large X-Large

Bunk Requests
Please list up to two campers you would like to be bunked with. Requests will be honored when possible and within camp guidelines. Placement of campers is done by grade in school.:
 
IMPORTANT
 
$150 Deposit per child must accompany each registration. (Includes $75 non-refundable registration fee, with the remaining $75 to be applied toward camp tuition). The balance is due by Wednesday, May 31st. Camp has limited enrollment and fills quickly. Please register early!
Rates:
  By March 19th 
1 wk/6 wks
After March 19th 
1 wk/6 wks
After June 22
1 wk/6 wks
All Ages $230 / $1,270 $245 / $1,335 $270 / $1485
Registration fee $75 / $75 $75 / $75 $75 / $75
Eitzim (6th-7th grade) activity fee $25 / $150 $20 / $150 $20 / $150
CIT 13 year old Girls $125 / $750 $125 / $750 $125 / $750
Before Care $25/week $25/week $25/week
Aftercare $60/week $60/week $60/week
Payment Plan:
Charge Full tuition Charge deposit Only
I will indicate when to have balance charged below:
 
Date: / / Amount:
Date: / / Amount:
*Unless indicated, balance will be charged on Wednesday, May 31st.
Card info:
Last Name First Name Address
City
State
Zip
 
Charge amount Card Type Card Number
Exp. Date
CVV code

3 digits on back
Comments
Terms of Agreement

I hereby agree that:I hereby give permission for my child to participate in all camp activities. In addition, I give Camp Gan Israel permission (a) to transport campers in connection with all camp activities including all swimming activities; (b) to render necessary first aid or to arrange care by medical personnel, if deemed necessary; (c) to use photographs and videos and names of campers in printed material and websites associated with Camp Gan Israel; (d) I indemnify and hold harmless Camp Gan Israel from any liability or claim for any loss, injury, damage or expense resulting or arising from my child’s participation in camp activities.

  Parent/Gaurdian Signature
Date:
In addition, I acknowledge that the camp administration reserves the right to reconsider the enrollment of any camper if we feel the child’s needs or level of functioning or behavior cannot be accommodated, or if the child’s conduct limits his or her ability to participate in, or to benefit fully from, the program and activities at Camp Gan Israel. In addition, I acknowledge that I have read and accept the financial obligations and the refund policy as stated in the application form.
  Parent/Gaurdian Signature
Date:

Notes

   

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