Camper Profile #1
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Sept. 2017)
Does your child have any allergies or other medical condition we should be aware of?
Please indicate which dates this child will be attending camp: Full Summer Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Camper Profile #2
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Sept. 2017)
Does your child have any allergies or other medical condition we should be aware of?
Please indicate which dates this child will be attending camp: Full Summer Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Parent And Background Information
Mother's Information
Full Name
Address
City, State, Zip
Home Phone Number
Cell Phone
E-mail Address
Father's Information
Full Name
Address
City, State Zip
Home Phone Number
Cell Phone Number
E-mail Address
Emergency Contact Information - In Addition To Parents
First Name
Last Name
Relationship to Child(ren)
Telephone Number
Address
City, State, Zip Code
Payment Options
Name on Card:
Card Type
Card Number
Exp. Date
CCV Number (on back of card)
Amount


I hereby register my child/ren in Camp Gan Israel and give my child permission to participate in all camp activities including trips. I understand that camp does not assume responsibility for any injury and in case of emergency, necessary medical attention may be secured by the camp.


I Accept

Full Name: