Registration

Parent and Family Information:
Adult #1 Name:*

First Name Last Name
Adult #1 Phone Number:*

Area Code Phone Number
Adult 1: E-mail:*

Adult #1 Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Adult #2 Name:

First Name Last Name
Adult #2 Phone Number:

Area Code Phone Number
Adult #2 Email:

Adult #2 Address (if different from above):

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is your child(ren)'s Father Jewish?*

Yes No
Is your child(ren)'s Mother Jewish?*

Yes No
Are there any conversions in the family?*

Yes No
If yes, please specify:
Are there any adoptions in the family?*

Yes No
If yes, please specify:
Where did you hear about us?
Synagogue Affiliation?
Student's Info:
Child's Name:*

First Name Last Name
Birth Date:*

Month Day Year
Gender:
School Attending:
Grade*
T-shirt Size:*
Has your child had another past winter camp experience?*

Yes No
If yes, please specify where.
What are your child's favorite activities?
Does your child have any special abilities or disabilities?*

Yes No
If Yes, please explain.
Is your child on any special medication that the camp should be aware of?**

Yes No
If Yes, please explain.
Camp Selection:

Camps regular hours are 9am-3pm every day
I am registering my child for:

Full Session One Day
Choose Day

December 27 December 28 December 29
I would like:

Early and late care (8am-5pm) $250 - Week 1 Early and late care (8am-5pm) $250 - Week 2 Early care (starting at 8am) - $125 - Week 1 Early care (starting at 8am) - $125 - Week 2 After care (until 5pm) - $125 - Week 1 After care (until 5pm) - $125 - Week 2
Add another child.
Child #2 Information
Name:

First Name Last Name
Birth Date

Month Day Year
Gender:
School Attending:
Grade (Entering into the 2022/2023 school year)
T-shirt Size:
Has your child had another past winter camp experience?

Yes No
If yes, please specify where.
What are your child's favorite activities?
Does your child have any special abilities or disabilities?

Yes No
If Yes, please explain.
Is your child on any special medication that the camp should be aware of?

Yes No
If Yes, please explain.
Camp Selection:

Camps regular hours are 9am-3pm every day
I am registering my child for:

Full Session
I would like:

Early and late care (8am-5pm) $250 - Week 1 Early and late care (8am-5pm) $250 - Week 2 Early care (starting at 8am) - $125 - Week 1 Early care (starting at 8am) - $125 - Week 2 After care (until 5pm) - $125 - Week 1 After care (until 5pm) - $125 - Week 2
Add another child.
Child #3 Information:
Name:

First Name Last Name
Birth Date:

Month Day Year
Gender:
School Attending:
Grade (Entering into the 2022/2023 school year)
T-shirt Size:
Has your child had another past winter camp experience?

Yes No
If yes, please specify where.
What are your child's favorite activities?
Does your child have any special abilities or disabilities?

Yes No
If Yes, please explain.
Is your child on any special medication that the camp should be aware of?

Yes No
If Yes, please explain.
Camp Selection:

Camps regular hours are 9am-3pm every day
I am registering my child for:

Full Session
I would like:

Early and late care (8am-5pm) $250 - Week 1 Early and late care (8am-5pm) $250 - Week 2 Early care (starting at 8am) - $125 - Week 1 Early care (starting at 8am) - $125 - Week 2 After care (until 5pm) - $125 - Week 1 After care (until 5pm) - $125 - Week 2
Emergency Information:
Emergency Contact Name:*

First Name Last Name
Emergency Contact Cell Phone Number:*

Area Code Phone Number
Emergency Contact Second Phone Number:

Area Code Phone Number
Physician's Name:*
Physician's Phone Number:*

Area Code Phone Number
Insurance Company:*
Insurance Policy Number:*
Payment Information:

Cost includes registration fee, camp T-shirt, all camp activities, trips and snacks.
I would like to kindly donate to the CGI Scholarship fund:

$
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Terms of Agreement:
I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Camp Gan Israel will undertake such a decision.
I give permission for my child's picture to be used in Camp Gan Israel's marketing material, website and media.
I give my child permission to attend all activities including all off-site trips and activities.
I give permission for Camp Gan Israel to sign any trip waivers on my behalf.
Comments:
Signature:

First Name Last Name
We look forward to a wonderful winter camp!
Should be Empty:

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Parent and Family Information:

Student's Info:

Camp Selection:

Camp Selection:

Camp Selection:

Emergency Information:

Payment Information:

Terms of Agreement: