Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
 First
Middle
Last
Address
 Street
City
State / Zip
 
Date of Birth

Date/Month/Year 

   
Contact Info
 Phone
Email
Schools
 School
Hebrew School
Entering Grade:
Child's Mother
 Mother's Name
Work Phone
Cell
Child's Father
 Father's Name
Work Phone
Cell
 
Emergency Info

In the event I cannot be reached, please contact:
Contact 1
 Name
Phone
Relationship
Contact 2
 Name
Phone
Relationship
Pediatrician
 Name

Phone
 

  

 

 

 I hereby give permission to the Gan Israel staff to obtain any medical treatment of my child, with the understanding that the family will be notified as soon as possible.
Signature
 Date
 
Select Child's Age Group
Ages 9 -12
Ages 3 - 5
  
Ages 6 - 8
 
  
 
Please indicate number of sessions your child will attend camp:
    

       

 Full session (June, 27- July, 15)
IMPORTANT
•

All forms must be completed and submitted before your child begins our program. Immunization forms from your child’s physician are due two weeks before the start of Gan Israel Jewish Adventures. 

 A $50 deposit is required.
I have read the brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
       Please indicate Early Bird Special if you registered before March, 31.
  Date of Application:
 
Pay Online
Name
 First
Middle
Last
Address
 Street
City
State    Zip
Card Info
 Amount
Card Type
Card Number
  Exp Date
CVV Code
Comments