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 10-12)
C.I.T's (Ages 13-16) (Week 1-3 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 30
Week 2 - July 7
Week 3 - July 14
Week 4 - July 21
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 1-3 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 30
Week 2 - July 7
Week 3 - July 14
Week 4 - July 21
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 1-3 only)

Sessions Attending & Additional Requirements*

Full Session
Week 1 - June 30
Week 2 - July 7
Week 3 - July 14
Week 4 - July 21
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 $230 each *

Price: $230.00

Early Bird (before May 9th) weekly at $210/each

Price: $210.00

Weekly TEEN Tuitions at $275 each (week 1-3 only)

Price: $275.00

Weekly Early Bird (before May 9th) TEEN Tuitions at $245 each (week 1-3 only)

Price: $245.00

Weekly Lunches at $20/per week *

Price: $20.00

Weeks of Morning Extended Care at $25 each

Price: $25.00

Weeks of Afternoon Extended Care at $25/each

Price: $25.00

Camp Hat and T-Shirt Sets at $20 *

Price: $20.00

Extra T-Shirts at $15 *

Price: $15.00

Extra Shirt Sizing

Total Amount

$0.00

Payment Method*

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

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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