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Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. CGI is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative activities, to both provide enjoyment and inspire children to try new and exciting things!
1. Child/ren’s Information
Child 1*

First Name Middle Name Last Name
Birth Date*

Month Day Year
Grade your child just finished:
Gender*

MaleFemale
T-Shirt Size One camp shirt is included per child, please specify if an additional shirt is needed in the comments below (additional charge will apply).
Child 2

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade your child just finished:
Gender

MaleFemale
T-Shirt Size One camp shirt is included per child, please specify if an additional shirt is needed in the comments below (additional charge will apply).
Child 3

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade your child just finished:
Gender

MaleFemale
T-Shirt Size One camp shirt is included per child, please specify if an additional shirt is needed in the comments below (additional charge will apply).
Child 4

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade your child just finished:
Gender

MaleFemale
T-Shirt Size One camp shirt is included per child, please specify if an additional shirt is needed in the comments below (additional charge will apply).
If you have additional children please contact us.
Sessions attending 9 am to 3:30 pm

Week 1: June 3 - 7Week 2: June 10-14Week 3: June 17-21
2. Parent information
Home Phone*

Area Code Phone Number

Address*

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

Parent Filling the Form*

First Name Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail* Primary email
Other Parent

First Name Last Name
Work Phone

Area Code Phone Number
E-mail
Cell Phone

Area Code Phone Number
How did you hear of Camp Gan Israel?
3. Emergency Information
Emergency Contact (if Parents cannot be reached*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician *

First Name Last Name
Dr. Office Phone Number

Area Code Phone Number
If this form is for multiple siblings and they have different Doctors, please specify over here.
The child/ren may be picked up from camp by:

Names
Does your child(ren) have any medical condition or allergies*

NoYes
Please note any allergies or medical conditions we would need to know about your child/ren
Please feel free to add anything else which you consider important to your child's success: (Fears, naps, difficulties, passion etc)
Permission for emergency medical treatment*

In case of any medical emergency whereby parents or legal guardians cannot be reached, I hereby authorize Camp Gan Israel to take appropiate medical action. If at any time the above information must be changed, I will notify the camp.
Date and time this form was filled out

Month Day Year
at Hour Minutes
4. Payment Information
RATES:

There is a $50 non-refundable registration fee due at this time to reserve your child's place. (For current Preschool and Grow Parents, it goes toward the summer camp tuition). Camp tuition is due before camp begins.

Rates: Main Camp: $225 per week, $665 for full summer (includes 2 hot lunches/per week)
Early Bird Discount (Register & pay deposit before April 30):
$200 per week, $590 for full summer
Sibling discount: 5% off the second child

Pre Care: 8:30 am - 9:00 AM $25 per week
After Care: 3:30 - 5:00 pm $30 Per week - No after care on Fridays.
$50 for both - per week

Tuition Assistance: Financial assistance may be available to your family. We encourage you to call Rabbi Pinchas at 727-631-7398 or email [email protected] to discuss how we can help make camp affordable for you. Your inquiry will be kept confidential.

Payment

Credit Card

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

Please accept my payment in the amount of*

$
Agreement:*

I hereby permit my child(ren) to be transported with camp transportation and to obtain medical emergency care as the situation mandates. I allow Camp Gan Israel to use my child(ren)'s photographs and videos for promotional purposes. I understand that my deposit is non refundable and that refunds will not be made for incomplete attendance. The parent signing this registration form acknowledges that he/she has the full authority to so and is responsible for all camp fees. I further release and agree to indemnify and hold harmless Camp Gan Israel and its officers, counselors or assigns from any liability concerning our child’s involvement in CGI and further agree that the use of any premises during the CGI camp day is made at the risk of the registrant
General comments
Should be Empty:

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1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information