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 InformationFamily Name*Address*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryPhone Number*Area CodePhone NumberFather's E-mail*Mother's E-mail*Mother's Name*First NameLast NameMother's Hebrew Name*Mother's Work Phone Number*Area CodePhone NumberMother's Cell Phone Number*Area CodePhone NumberFather's Name*First NameLast NameFather's Hebrew Name*Father's Work Phone Number*Area CodePhone NumberFather's Cell Phone Number*Area CodePhone NumberEmergency Contact Person*First NameLast NameEmergency Contact Phone Number*Area CodePhone NumberRelationship*Emergency Contact Person*First NameLast NameEmergency Contact Phone Number*Area CodePhone NumberRelationship*Pediatrician Name*First NameLast NamePediatrician Phone Number*Area CodePhone NumberWho can we thank for referring you?*Number of children being registered:*Camper InformationName*Gender*MFDate of Birth*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchool*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 sizesS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2XAge group*Please indicate weeks attending below.Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7Explorers/Trailblazers attending:Full SessionWeek 1Week 2Week 3Week 4Pioneers attending:Full SessionWeek 1Week 2Week 3Week 4I 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 InformationFull NameFirst NameLast NameGenderMFDate of Birth1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchoolEntering GradeMedicationAllergiesHealth 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 sizesS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2XAge groupPlease indicate weeks attending below.Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7Explorers/Trailblazers attending:Full SessionWeek 1Week 2Week 3Week 4Pioneers attending:Full SessionWeek 1Week 2Week 3Week 4I 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 InformationFull NameFirst NameLast NameGenderMFDate of Birth1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchoolEntering GradeMedicationsAllergiesHealth 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 sizesS (6-8)M (10-12)L (12-14)XL (14-16)(A) S(A) M(A) L(A) XL(A) 2XAge groupPlease indicate weeks attending below.Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7Explorers/Trailblazers attending:Full SessionWeek 1Week 2Week 3Week 4Pioneers attending:Full SessionWeek 1Week 2Week 3Week 4I 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)IMPORTANTAll 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$1000Questions/Comments:Total$0.00Payment*Credit CardWe accept Visa, MasterCard, American Express, DiscoverCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2023202420252026202720282029203020312032Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryI 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: Submit This page uses TLS encryption to keep your data secure.