Day Camp Registration Form

Gan Israel winter Camp Registration Form

December 29 - January 2. 9 am - 4 pm.
Camper's Information

Personal & Health & Contact
Name

First NameLast Name
Birth Date

MonthDayYear
Age
Grade
T-shirt Size:

Other
List Any Allergies and Dietary Restrictions
Medications & Frequency
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name

First NameLast Name
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts and Authorized Pick Up Persons
I allow pictures/videos of my child to be used for camp updates or promotional materials.
Camp payment

Scholarships available, reach out to Rabbi Mendel

Chabad winter camp 2025-26$50.00

Camp deposit

Total $0.00

Gan Israel winter Camp Registration Form