Registration - Camp Gan Israel

Family Information

How many children are you registering today?*

1
2
3

Family Name*

Address*

Street Address Line 2 City State Zip Country

Phone*

Email*

Mother

Mother's Name Hebrew Name

Work Phone

Cell

Father

Father's Name Hebrew Name

Work Phone

Cell

Emergency Contact Info

Phone

Relationship

Emergency Contact Info

Phone

Relationship

Pediatrician

Phone

Camper 1 Information

Name*

First Name Last Name

Gender*

Male
Female

Date of Birth*

School

Entering Grade

Quick Health Notes

Allergies

Health Problems or Disabilities

T-shirt Size*

(A) implies adult sizes

Age Group*

Younger Div (Ages 3-9)
VIP's (Age 7-9)
Pioneers (Ages 10-11)
C.I.T's (Ages 12-15) (Week 2-4 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 24
Week 2 - July 1
Week 3 - July 8
Week 4 - July 15
Yes, I will need Before Care 8:00-9:00 am
Yes, I will need After Care 3:30-5:00 pm

Camper 2 Information

Name*

First Name Last Name

Gender*

Male
Female

Date of Birth*

School

Entering Grade

Quick Health Notes

Allergies

Health Problems or Disabilities

T-shirt Size*

(A) implies adult sizes

Age Group*

Younger Div (Ages 3-9)
VIP's (Age 7-9)
Pioneers (Ages 10-11)
C.I.T's (Ages 12-15) (Week 2-4 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 24
Week 2 - July 1
Week 3 - July 8
Week 4 - July 15
Yes, I will need Before Care 8:00-9:00 am
Yes, I will need After Care 3:30-5:00 pm

Camper 3 Information

Name*

First Name Last Name

Gender*

Male
Female

Date of Birth*

School

Entering Grade

Quick Health Notes

Allergies

Health Problems or Disabilities

T-shirt Size*

(A) implies adult sizes

Age Group*

Younger Div (Ages 3-9)
VIP's (Age 7-9)
Pioneers (Ages 10-11)
C.I.T's (Ages 12-15) (Week 2-4 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 24
Week 2 - July 1
Week 3 - July 8
Week 4 - July 15
Yes, I will need Before Care 8:00-9:00 am
Yes, I will need After Care 3:30-5:00 pm

Payment Information

Weekly Tuitions at $180 each*

Price: $180.00 Quantity:

Early Bird weekly at $160/each

Price: $160.00 Quantity:

Weekly TEEN Tuitions at $250 each (week 2-4 only)

Price: $250.00 Quantity:

Weekly Early Bird TEEN Tuitions at $230 each (week 2-4 only)

Price: $230.00 Quantity:

Weekly Lunches at $15/per week*

Price: $15.00 Quantity:

Weeks of Morning Extended Care at $25 each

Price: $25.00 Quantity:

Weeks of Afternoon Extended Care at $25/each

Price: $25.00 Quantity:

Camp Hat and T-Shirt Sets at $15*

Price: $15.00 Quantity:

Extra T-Shirts at $15*

Price: $15.00 Quantity:

Extra Shirt Sizing

Total Amount

$0.00

Payment Method*

I will send a check by June 10th (April 30 for early-bird)
Please charge my card the above total.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Online Registration

experience the summer of your lifetime

Family Information

Camper 1 Information

Camper 2 Information

Camper 3 Information

Payment Information

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