Camp Gan Israel Forms 2025

My Child's Profile
Full Name*

First NameLast Name
Name Called *
How would you like your child's name to appear around the classroom and on projects?*
Hebrew Name
Is your child receiving any services / has received any services during this past school year?*

YesNo
Type of service:
Times per week:
Location:
Name of therapist:
Therapists phone number:
Please enter a valid phone number.
My Child is toilet trained:*

YesNo
Please feel free to add anything else, which you consider important to your child's success:*

Emergency Contact
Emergency Contact #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to child:*
Emergency contact #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to child:*
In case of any medical emergency whereby parents or legal guardians cannot be reached, I hereby authorize Camp Gan Israel to take appropriate medical action.
Parent E-Signature*

Clear

Allergy Alert

Camp Gan Israel is a nut-aware Camp! All food items sent to camp must be nut free and free of any traces of nuts . Lunch is provided daily from nut aware facilities. Please read all labels to ensure the health and safety of all of our campers. Thank you for your cooperation on this matter!
Does your child have any allergies? *
Please include all allergies, including any indicated in the camp application
What should be done in the event of an allergic reaction?
Does your child have an epi-pen?
Does your child have any medical conditions that camp should be aware of?
We are not authorized to administer any medication including nebulizers.
Medical Form
You can either request a medical record from your child's pediatrician or Click here to download a medical form to be completed by your child's pediatrician.

Please email your medical form to Chabad@ChabadFiveTowns.com - subject line should be Camp Medical Form or fax it to 516-295-7840

Permission & Release
I understand that pictures and/or videos taken of my child at Camp Gan Israel during camp hours may be posted on the Camp Gan Israel website or on Camp Gan Israel /Chabad social media and may be used for promotional purposes.
I hereby give permission for my child to go on all walking outings with his / her bunk throughout the summer:*

Clear

Validity of Signatures

My E-Signature on all the above forms constitutes my valid, legal signature.
Legal Name*

First NameLast Name
Email*
example@example.com
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

My Child's Profile