camp gan israel

CAMP GAN ISRAEL REGISTRATION Summer 2018
1. Child/ren’s Information
Child 1*

First Name Last Name Hebrew Name
Birth Date*

Month DayYear
Gender*
MaleFemale
Grade Entering
Weeks Attending*
Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20
Tshirt Size
Please indicate any medical, allergy, behavioral or IEP information
Child 2
First NameLast NameHebrew Name
Birth Date
MonthDayYear
Gender
MaleFemale
Grade Entering
Weeks Attending*
Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20
Tshirt Size
Please indicate any medical, allergy, behavioral or IEP information
Child 3
First NameLast NameHebrew Name
Birth Date
MonthDayYear
Gender
MaleFemale
Grade Entering
Weeks Attending*
Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20
Tshirt Size
Please indicate any medical, allergy, behavioral or IEP information
Early Care/After Care
8am - 9am l $20 a week per child3pm - 5:30pm l $45 a week per child
2. Parent information
Home Phone Number*
Area CodePhone Number

Home Address*

Mother's info
First NameLast Name
Cell Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mailPrimary email
Father's info
First NameLast Name
Cell Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mail
How did you hear of us?
3. Emergency Information
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
4. Payment Information
Payments
Pay Deposit Only for 1 ChildPay Deposit Only for 2 ChildrenPay Deposit Only for 3 Children
Total
$50.00

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Agreement*
Application Information: Tuition fees & Refund policy: A $50 deposit is due upon registration and is non refundable. Camp cost is $175 per week. All fees must be paid by June 25th. The Early Bird Discount will be applied if registration and the $50 deposit is submitted by April 10, 2018. Permissions: I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation. My child has permission to participate in any field trip or activity done with Camp Gan Israel of Gilbert. Camp Gan Israel will make every effort to insure the well-being of every camper. However, it will not be responsible for any injury or health impairment of any camper. Gan Israel will not be responsible for damage to or loss of clothing or personal belongings. I allow Camp Gan Israel to use my child(ren)’s photograph for all promotional purposes. In the event of an emergency, illness, or accident, Camp Gan Israel has my permission to arrange any necessary first-aid or care by a paramedic or licensed physician for my child/ren while he/she is attending camp. I agree to all the terms & information listed herein.
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CAMP GAN ISRAEL REGISTRATION Summer 2018