Camp Gan Israel Registration

Camp Gan Israel Registration

Register your child for an unforgettable summer at Camp Gan Israel! Please provide family and camper details below.
Camper Information
Camper Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
MaleFemaleOther
Grade entering this fall*
YesNo
If you selected yes, please specify
General Medical Health Form*

Cancelof
Immunization Record*

Cancelof
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian 1 Information
Parent/Guardian 1 Full Name*

First NameLast Name
Relationship to Camper*
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Work Number*
Please enter a valid phone number.Format: (000) 000-0000.
CellphoneWork Phone
Parent/Guardian 2 Information
Parent/Guardian 2 Full Name

First NameLast Name
Relationship to Camper
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Work Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup Person(s) in addition to parent/guardian
Name*

First NameLast Name
Relationship to Camper*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Additional Consent Options
YesNo
YesNo
YesNo
YesNo
Camp Handbook
YesNo
Additional Comments or Special Instructions
Payment

Price includes a $50 non refundable security fee for full time security on the premises.

1 Week

360 + 50 security fee

$410.00 Quantity

Full 2 week program

720 + 50 security fee

$770.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Camp Gan Israel Registration

Camper Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact

Authorized Pickup Person(s) in addition to parent/guardian

Additional Consent Options

Payment