| Camper/Parent Information |
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Name
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First
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Middle |
Last |
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Address
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Street
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City |
State
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Zip
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Date of Birth
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Contact Info
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Phone
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Email
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Schools
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School
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Hebrew School |
Entering Grade:
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Child's Mother
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Mother's Name |
Work Phone |
Cell
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Child's Father
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Father's Name
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Work Phone
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Cell
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Emergency Contact Info
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Name
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Phone |
Relationship |
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Pediatrician
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Name
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Phone |
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Email
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Select Child's Age Group
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Ages 4-6 |
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Ages 6-8 |
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Ages 8-10 |
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| Please indicate number of sessions your child will attend camp: |
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Session 1 Session 2 Both Sessions |
| IMPORTANT |
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All forms must be completed and submitted before your child begins camp. |
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I will be paying by: Check Credit Card |
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I have read the camp brochure and application form and agree to the terms stated. By submitting this form I give Camp Gan Israel and all agents thereof permission to take my child/ren off site for field trips and to receive medical care in the case of emergency.
The camp reserves the right to dismiss, at its sole discretion, any camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interest of the camp or his/her fellow campers or who violates camp rules and regulations, in which case no refunds will be made.
Participation in Camp Gan Israel sponsored activities constitutes permission to use photos of participants for promotional purposes. |
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Date of Application: |
