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.
July 27 - August 7 | 9:00am - 3:00pm | Ages 5-10
Camper Information
Camper Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender

Other
Grade entering this fall
Does your child have any allergies or medical conditions?
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.
During the hours that my child is at CGI the best way to reach me is:
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
Emergency Medical Treatment - I hereby give my consent to Alef Academy to call a doctor or emergency medical service and for that doctor or emergency service to provide emergency medical or surgical treatment to my child.
Sun Screen - I hereby give my permission for staff to apply Sunscreen to my child prior to outside play.
Media Release - I hereby grant my permission for my child's photo to be taken and used in newsletters, flyers, and/or for any other advertisement purposes.
I acknowledge the camp's health and safety policies
Camp Handbook
I have read and agree to the terms in the camp handbook
Additional Comments or Special Instructions
Payment

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

Week 1 (Jul 27-31)

360 + 50 security fee

$410.00 Quantity

Week 2 (Aug 3-7)

360 + 50 security fee

$410.00 Quantity

Full 2 Week Program

720 + 50 security fee

$770.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Camp Gan Israel Registration

July 27 - August 7 | 9:00am - 3:00pm | Ages 5-10

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

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