Camp Gan Izzy - Registration Form 2020 

Please complete the entire form.

 

 Campers Info:

Last Name:

 

First Name:

Hebrew Name:

 

Date Of Birth:  Gender:

Home Address:

 

City: State: Zip Code:

Home Phone:

Parent E-mail:

School Sept. 2019-20: Entering Grade:  

Parent:   Cell Phone:  

Parent:   Cell Phone:

Are parents Jewish by birth, non Jewish, converted, or considering conversion?

Father:   Mother: 

Synagogue affiliated with:  

Emergency contact name & relationship to child:   Phone:

Pediatrician Name:   Pediatrician Phone:

Allergies? (If yes, please describe them and indicate special precautions or care needed).

 

Are your child’s immunizations up to date? 

Date of last tetanus booster? 

Session and Fee

 

Week One: June 29- July 3 $185

Week Two: July 6 - 10 $185

Week Three: July 13- July 17 $185

Week Four: July 20- 24 $185

Full Summer: $700

I would like to sponsor a child for a week of fun $185 

Payment information

$50 registration fee to save your spot (deducted from tuition) 

I will send a check: Payable to Camp Gan Israel 

Credit Card Type:

Name on card:

Credit Card Number:

Ex. Date (Day/Month):

CVV-Code:

In case of emergency, I request Camp Gan Israel Day Camp to contact me. If the camp is unable to reach me, I hereby authorize the camp to call the physician indicated above and to follow his instructions. If camp cannot contact this physician, the camp may make whatever arrangements seem necessary. I hereby give permission for campers to attend all the field trips the camp will be taking. I understand that the camp will provide transportation, and that safety precautions will be taken at all times. Gan Israel will make every effort to insure the well-being of every camper. However, it will not be responsible for any injury or health impairment of any camper. Gan Israel will not be responsible for damage to or loss of clothing or personal belongings of any camper.

I allow Camp Gan Israel to use my child(ren)’s photograph for all promotional purposes.

I understand that my deposit is non-refundable, and that refunds will not be made for incomplete attendance. I fully understand and agree to these conditions, and have stated all of the above information correctly

The parent who signs this registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fees. 

I Agree


Signature