Register

Child 1*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

School Attending

Entering Grade

T-shirt Size*

If you are only registering one child you may scroll down to the Fees Section.

Child 2

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

School Attending

Entering Grade

Session 1: June 15 - June 19Session 2: June 22 - June 26Session 3: June 29 - July 3All Sessions

T-shirt Size

Child 3

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Entering Grade

School Attending

Session 1: June 15 - June 19Session 2: June 22 - June 26Session 3: June 29 - July 3All Sessions

T-shirt Size

Child 4

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Entering Grade

School Attending

T-shirt Size

Session 1: June 15 - June 19Session 2: June 22 - June 26Session 3: June 29 - July 3All Sessions

1 Session- $180

2 Sessions- $360
Sibling Discount - 5%

Early Bird Discount (before April 25) - 5%

Cost includes registration fee, camp T-shirt, all camp activities and trips

Need a campership? Call Rabbi Mendel or Dini 904-701-4422

*

Session 1: June 15 - June 19Session 2: June 22 - June 26Session 3: June 29 - July 3All Sessions

Phone Number*

Area CodePhone Number

Address*

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

Mother's info

First NameLast Name

Phone Number (Best way to reach you)

Area CodePhone Number

E-mailPrimary email

Father's info

First NameLast Name

Phone Number (Best way to reach you)

Area CodePhone Number

E-mail

How did you hear of us?

Emergency Contact*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Pediatrician

First NameLast Name

Phone Number

Area CodePhone Number

Insurance

Policy #

Total

$0.00

Payment

Credit Card Other

Agreement*

I give permission for my child's picture to be used in Camp Gan Izzy's marketing material and website.I give my child permission to attend all activities including all off-site trips and activities, and receive medical care in the case of emergency.

General comments

1. Child/ren’s Information

Fees

2. Parent information

3. Emergency Information

4. Payment Information

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1. Child/ren’s Information

Fees

2. Parent information

3. Emergency Information

4. Payment Information