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Camp Registration

Camp Registration

 

Camp Gan Israel

Summer 2017

June 26th - July 21th

Boys and Girls Ages 4-12

Mini-Gan - Ages 2- 3

Week 1 - June 26 - June 30

Week 2 - June 3- July 7

Week 3 - July 10 - July 14

Week 4 - July 17  - July 21

Parent's Information
Mother's Name
Father's Name
Address 1
Address 2
City
State/Zip
Home phone
E-mail
Mother's Cell
Father's Cell
Mother's Work

Father's Work

Camper's Information
Camper 1: Name
Hebrew name
Date of birth
Age
Grade
Previous Hebrew Education
Camper 2: Name
Hebrew name
Date of birth
Age
Grade
Previous Hebrew Education
Camper 3: Name
Hebrew name
Date of birth
Age
Grade
Previous Hebrew Education
 

My child will attend:
All 4 Weeks
Week of:
Week 1 Week 2 Week 3 Week 4

Any medical or other information regarding your child we should be aware of:
Emergency Contact
Name
Relationship
Phone
Name
Relationship
Phone
I herby permit my child to participate in all CGI activities. I also permit my child to join all trips beyond the program property.
In case of emergency I hereby authorize the CGI Program to have my child taken care of by a physician in any way the situation may call for.
Payment Information
Payment Info: $150 per week plus $10 (t-shirt)
Payment Method
CC check/other
Total $ Card Type
Card Number Expiration Date
CVV
Billing Address: IF DIFFERENT FROM ADDRESS ABOVE
Address Address 2 City/State/Zip
Comments

 

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