Registration & Information Form

Camp Gan Israel registration form 2024
Family's last name:*
Father/Guardian Information
Name:*

First Name Last Name
E-mail:*
Cell phone:*

Area Code Phone Number
Home phone:

Area Code Phone Number

Home address:*

Street Address
Subdivision
City	State / Province
Postal / Zip Code	Country

Mother/Guardian Information
Name:*

First Name Last Name
E-mail:*
Cell phone:*

Area Code Phone Number
Home phone:(if different)

Area Code Phone Number

Home address: (if different)

Street Address
Subdivision
City	State / Province
Postal / Zip Code	Country

Family Information
Are the child(ren)'s natural parents Jewish by birth?*

YesNo (please explain below)
If no, please explain:
Have there been any conversions or adoptions in your family? (including grandparents)*

Yes (please explain below)No
If yes, please explain:
Emergency Contact Information

In case of emergency, if parent or guardian cannot be reached, please contact:
Contact 1 (name, phone & relationship):*
Contact 2 (name, phone & relationship):
Other than parents and emergency contacts, list any people authorized to pick-up students. (name and phone):
Child #1 Information
Name:*

First Name Last Name
Hebrew name:
Birth date:*

Month Day Year
Select t-shirt size (Children's Sizes)

Small (6-8)Medium (10-12)Large (14-16)Extra LargeAdult SmallAdult Medium
Lives with:*

MotherFatherBoth
Entering grade:*
Knowledge of basic Judaism is:*
Any food, medical or insect allergies? If yes, please specify.*
Any physical or learning limitations we should be aware of? If yes, please explain.*
Please list any other information of importance:
Child #2 Information
Name:

First Name Last Name
Hebrew name:
Birth date:

Month Day Year
Select t-shirt size (Children's Sizes)

Small (6-8)Medium (10-12)Large (14-16)Extra LargeAdult SmallAdult Medium
Lives with:

MotherFatherBoth
Entering grade:
Knowledge of basic Judaism is:
Any food, medical or insect allergies? If yes, please specify.
Any physical or learning limitations we should be aware of? If yes, please explain.
Please list any other information of importance:
Child #3 Information
Name:

First Name Last Name
Hebrew name:
Birth date:

Month Day Year
Select t-shirt size (Children's Sizes)

Small (6-8)Medium (10-12)Large (14-16)Extra LargeAdult SmallAdult Medium
Lives with:

MotherFatherBoth
Entering grade:
Knowledge of basic Judaism is:
Any food, medical or insect allergies? If yes, please specify.
Any physical or learning limitations we should be aware of? If yes, please explain.
Please list any other information of importance:
Weeks Attending:*

Week 1: July 1 - 5Week 2 July 8 - 12Week 1 & 2
Cost per child:

Registration Fee: $50

$300 per week.

Pioneer Girls Program: $350 per week.

Please click below the amount you would like to pay today.
Registration fee:

$50
Registration fee: (for 2 Children)

$100
Registration fee: (for 3 Children)

$150
Week 1:

$300
Week 2:

$300
Week 1: (for 2 children)

$600
Week 2: (for 2 Children)

$600
Week 1: (for 3 Children)

$900
Week 2: (for 3 Children)

$900
For the Pioneer Girls program, please add an additional $50 per week.

$50$100
I would like to set up a payment plan
Total

$0.00

Payment

Credit Card Paypal

Postal / Zip Code

Country

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Camp Gan Israel registration form 2024

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