Junior Counselors Parents - Young Israel - Chabad of Pinellas County

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. Counselor Information
Counselor Name:*
First Name Middle Name Last Name
Counselors Birthdate:*

Month Day Year
Counselor Allergies:
Counselor T-Shirt Size*
2. Parent information
Home Phone*

Area Code Phone Number

Address*

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
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
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.
General comments
Optional Contribution to offset trip chaperone costs and provide daily security

$18$36$54$180
*

I have read through the contract with my child and they agree to follow all rules and protocols of CGI
Should be Empty:

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1. Counselor Information