New Camp Registration Form

Summer 2026:

Week 1: June 29-July 3
Week 2: July 6-10
Week 3: July 13-17
Week 4: July 20-24
Week 5: July 27-31
For rates www.campsimchamonica.com
Minimum enrollment: 2 weeks
Tuition:

Register for 2 weeks: $475 a week
Register for 3-4 weeks: $465 a week
Register for the entire summer (5 weeks): $2250

Early Bird Special:Register by April 30 for 10 % off Total
Sibling Discount: 5 % off 2nd child, 3rd child, 4th child.

$200 deposit per child must be paid with registration (will go towards your tuition.)
1. Child/ren’s Information
How many children will you be registering

1234
Child 1*
Given first Name Last Name How is he/she called
Jewish or Hebrew Name (if different than above)
Gender*

MaleFemale
Birth Date*

Month Day Year
Age & School*
Age School Current Grade (for pre school indicate 3 or 4 year old class)
Program*

Main Camp (Grades k-6)MasmidimMini Gan Izzy (ages 3-4)Pioneers Girls (grades 7-8)
Weeks*

Entire summerWeek 1Week 2Week 3Week 4Week 5
Does your child take any medication*

NoYes
Will they be needing medication*

During camp hoursAfter camp hoursWill not be taking any medication during the summer
List medications*
Any allergies*

NoYes
Epipen*

NoYes
List allergies*
Shirt size*
Child 2
Given first Name Last Name How is he/she called
Jewish or Hebrew Name (if different than above)
Gender

MaleFemale
Birth Date

Month Day Year
Age & School
Age School Current Grade (for pre school indicate 3 or 4 year old class)
Program*

Main Camp (Grades k-6)MasmidimMini Gan Izzy (ages 3-4)Pioneers Girls (grades 7-8)
Weeks

Entire summerWeek 1Week 2Week 3Week 4Week 5
Does your child take any medication

NoYes
Will they be needing medication*

During camp hoursAfter camp hoursWill not be taking any medication during the summer
List medications*
Any allergies

NoYes
Epipen*

NoYes
List allergies*
Shirt size
Child 3
Given first Name Last Name How is he/she called
Jewish or Hebrew Name (if different than above)
Gender

MaleFemale
Birth Date

Month Day Year
Age & School
Age School Current Grade (for pre school indicate 3 or 4 year old class)
Program*

Main Camp (Grades k-6)MasmidimMini Gan Izzy (ages 3-4)Pioneers Girls (grades 7-8)
Weeks

Entire summerWeek 1Week 2Week 3Week 4Week 5
Does your child take any medication

NoYes
Will they be needing medication*

During camp hoursAfter camp hoursWill not be taking any medication during the summer
List medications*
Any allergies

NoYes
Epipen*

NoYes
List allergies*
Shirt size
Child 4
Given first Name Last Name How is he/she called
Jewish or Hebrew Name (if different than above)
Gender

MaleFemale
Birth Date

Month Day Year
Age & School
Age School Current Grade (for pre school indicate 3 or 4 year old class)
Program*

Main Camp (Grades k-6)MasmidimMini Gan Izzy (ages 3-4)Pioneers Girls (grades 7-8)
Weeks

Entire summerWeek 1Week 2Week 3Week 4Week 5
Does your child take any medication

NoYes
Will they be needing medication*

During camp hoursAfter camp hoursWill not be taking any medication during the summer
List medications*
Any allergies

NoYes
Epipen*

NoYes
List allergies*
Shirt size
2. Parent information

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number
Mother's info
First Name Last Name Hebrew Name
Mother's Cell Phone
Mother's Work Phone
Mother's E-mail
Father's info
First Name Last Name Hebrew Name
Father's Cell Phone
Father's Work Phone
Father's E-mail
3. Emergency Information
Emergency Contact
First Name Last Name Phone Number
Relationship
Pediatrician
First Name Last Name Name Phone Number
4. Payment Information
Total

$0.00
Acknowledgement:
I am signing up my child for camp. I give my child permission to attend all trips including swimming and receive medical care in the case of emergency, G-d forbid.
I give Gan Israel permission to photograph and video my children and use the photos and videos (without their names).
Special payment arrangements must be made before camp starts. If no special arrangement is made, the camp tuition will be charged to this credit card on a weekly basis.
I agree to the above*

Yes
E-mail of parent registering*

Payment

Credit Card Other

Postal / Zip Code

Country

General comments
I would like to receive news and updates by email
Please check the above check box so that you are included in the camp email list. If you would like to add another email address to this list please click here.
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Upcoming Events

There are no events posted at this time. Please contact us for more info about our events.

We are only taking a select number of campers this year. Reserve your space before it is too late.

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information