Register Online

Click here for dates and rates. For those paying with check or requesting a scholarship, please complete this form and scan/mail to our office.
Limited availability, first come first serve basis.
To register more than one child, please complete this form in its entirety, and then complete the sibling form here.
Family Information
Family Name*

Address*

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

Phone Number*
Area CodePhone Number
Father's E-mail*
Mother's E-mail*
Mother's Name*
First NameLast Name
Mother's Hebrew Name*
Mother's Work Phone Number*
Area CodePhone Number
Mother's Cell Phone Number*
Area CodePhone Number
Father's Name*
First NameLast Name
Father's Hebrew Name*
Father's Work Phone Number*
Area CodePhone Number
Father's Cell Phone Number*
Area CodePhone Number
Emergency Contact Person*
First NameLast Name
Emergency Contact Phone Number*
Area CodePhone Number
Relationship*
Emergency Contact Person*
First NameLast Name
Emergency Contact Phone Number*
Area CodePhone Number
Relationship*
Pediatrician Name*
First NameLast Name
Pediatrician Phone Number*
Area CodePhone Number
Who can we thank for referring you?*
Number of children being registered:*
Camper Information
Name*
Gender*
Date of Birth*
MonthDayYear
School*
Entering Grade*
Medication*
Allergies*
Health Issues, disabilities or special needs of child:*
I would like to order the following amount of tshirts:*
$12 each - Must be ordered by June 1.
T-shirt size(A) implies adult sizes
Age group*Please indicate weeks attending below.
Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7
Explorers/Trailblazers attending:
Full SessionWeek 1Week 2Week 3Week 4
Pioneers attending:
Full SessionWeek 1Week 2Week 3Week 4
I will need the following amount of weeks of before care ($25/week)
I will need the following amount of weeks of after care ($25/week)
Child 2 Information
Full Name
First NameLast Name
Gender
Date of Birth
MonthDayYear
School
Entering Grade
Medication
Allergies
Health Issues, disabilities or special needs of child:
I would like to order the following amount of tshirts:$7/each - Must be ordered by June 1.
T-shirt size(A) implies adult sizes
Age groupPlease indicate weeks attending below.
Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7
Explorers/Trailblazers attending:
Full SessionWeek 1Week 2Week 3Week 4
Pioneers attending:
Full SessionWeek 1Week 2Week 3Week 4
I will need the following amount of weeks of before care ($25/week)
I will need the following amount of weeks of after care ($25/week)
Child 3 Information
Full Name
First NameLast Name
Gender
Date of Birth
MonthDayYear
School
Entering Grade
Medications
Allergies
Health Issues, disabilities or special needs of child:
I would like to order the following amount of tshirts:$7/each - Must be ordered by June 1.
T-shirt size(A) implies adult sizes
Age groupPlease indicate weeks attending below.
Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7
Explorers/Trailblazers attending:
Full SessionWeek 1Week 2Week 3Week 4
Pioneers attending:
Full SessionWeek 1Week 2Week 3Week 4
I will need the following amount of weeks of before care ($25/week)
I will need the following amount of weeks of after care ($25/week)
IMPORTANT
All forms must be completed and submitted before your child begins camp.
Click here to access the scholarship form.
Agreement:*
I authorize Camp Gan Israel to charge my card the full tuition amount once accepted.
New! Security at Camp:
We have employed full time security during camp hours, but have not raised the registration costs of camp. Please consider a donation to the security fund to help cover the large increase in our budget:
$100$180$360$1000
Questions/Comments:
Total
$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I have read and agree to the terms and conditions . I authorize Camp Gan Israel, to have my child treated in case of emergency by a physician in the manner such person deems necessary. I further give permission for my child to attend and be transported on camp trips.

Please type your name here:*
Date of Application:*
Discount Code (one per family)Discounts will be applied before your card is charged.
Should be Empty:

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Family Information

Camper Information

Child 2 Information

Child 3 Information

IMPORTANT

New! Security at Camp: