Register Online

Click here for dates and rates, please review as rates have changed. For those requesting a scholarship, please complete this form.

Limited availability, first come first serve basis.
Limited Availability for Grades K - 1.
Contact Mushkie at 727-430-0473 for more information.

Kindly be advised that T-shirt sizes and quantities requested after April 30 are subject to availability.
Family Information
Family Name*

Address*

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

Phone Number*

Area Code Phone Number
Father's E-mail*
Mother's E-mail*
Mother's Name*
First Name Last Name
Mother's Hebrew Name*
Mother's Work Phone Number*

Area Code Phone Number
Mother's Cell Phone Number*

Area Code Phone Number
Father's Name*
First Name Last Name
Father's Hebrew Name*
Father's Work Phone Number*

Area Code Phone Number
Father's Cell Phone Number*

Area Code Phone Number
Emergency Contact Person*
First Name Last Name
Emergency Contact Phone Number*

Area Code Phone Number
Relationship*
Emergency Contact Person*
First Name Last Name
Emergency Contact Phone Number*

Area Code Phone Number
Relationship*
Pediatrician Name*
First Name Last Name
Pediatrician Phone Number*

Area Code Phone Number
Who can we thank for referring you? *
Number of children being registered:*
Camper Information
Name*
Gender*
Date of Birth*

Month Day Year
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* (New Color This Summer) (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 Name Last Name
Gender
Date of Birth

Month Day Year
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 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 3 Information
Full Name
First Name Last Name
Gender
Date of Birth

Month Day Year
School
Entering Grade
Medications
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)
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.
Mr. Jackson - Camp Security:
We have employed full time security during camp hours. Please consider a donation to the security fund to help cover the large increase in our budget:

$180$360$540$1000
Questions/Comments:
Total

$0.00

Payment*

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Credit Card

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Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

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.
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Family Information

Camper Information

Child 2 Information

Child 3 Information

IMPORTANT

Mr. Jackson - Camp Security: