Summer Camp Registration

Camper Information

First Name

Last Name

Hebrew Name

Gender

Date of Birth

Grade

Allergies

Note

Parent 1

Relation

First Name

Last Name

Cell Phone

Parent 2

Relation

First Name

Last Name

Cell Phone

Family Information

Address

City

State

Zip

Home Phone

Marital Status

Have there been any adoptions or conversions in the family?

If yes, please explain

Emergency Information

Name

Phone

Relation

Enrollment Options / Tuition & Fees

Tuition is $350 per week. Early Bird Discount before April 1: $325 per week. Sign up for all 4 weeks for an additional 10% off.

Please check which Weeks your child will be attending.

Week 1: June 22 - June 26

Week 2: June 29 - July 3

Week 3: July 6 - July 10

Week 4: July 13 - July 17

Please indicate if you will need early drop-off or late pickup

Early Care: 8-9am: $40 / Week

After Care 3-5pm: $60 / Week

Total Amount

Tution fees will be charged to your card upon acceptance of your child prior to the start of camp. A registration fee of $40 will be charged upon submitting this form.

Payment Information

Registration Fee

Card Type

Number

Expiration

Code

Use contact info above

Name

Address

Zip

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Camp Gan Israel to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Camp Gan Israel personnel will try, but are not required, to communicate with me/us prior to such treatment. It is also understood that Camp Gan Israel can take photos and videos of your child and display them on the camp website and otherwise publicize them.

I agree to the terms and conditions above

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