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.

FIRST WEEK $25 WITH ALEXANDER INITIATIVE! Conditions apply.

Use promo code '25CAMPER'.*

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 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?*

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 group*Please indicate weeks attending below.

Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7

Explorers/Trailblazers attending:

Full SessionWeek 1Week 2Week 3

Pioneers attending:

Full SessionWeek 1Week 2Week 3

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)

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 3

Pioneers attending:

Full SessionWeek 1Week 2Week 3

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)

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 3

Pioneers attending:

Full SessionWeek 1Week 2Week 3

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)

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.

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

Credit Card Type
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.

Family Information

Camper Information

Child 2 Information

Child 3 Information

IMPORTANT

New! Security at Camp: