Register

1. Child/ren’s Information
Number of Children Registering:* Non-refundable registration Fee: $50/child
(This will be applied towards your total camp fee)
Child 1:*
First Name Middle Name Last Name
Birth Date:*

Month Day Year
Gender:*

MaleFemale
School Attending:
Entering Grade:
T-shirt Size:*
Registration:*

Session 1: June 30 - July 3Session 2: July 7 - July 11Session 3: July 14 - July 18All Sessions
Child 2:
First Name Middle Name Last Name
Birth Date:

Month Day Year
Gender:

MaleFemale
School Attending:
Entering Grade:
Session 1: June 30 - July 3Session 2: July 7 - July 11Session 3: July 14 - July 18All Sessions
T-shirt Size:
Child 3:
First Name Middle Name Last Name
Birth Date:

Month Day Year
Gender:

MaleFemale
Entering Grade:
School Attending:
Session 1: June 30 - July 3Session 2: June 7 - July 11Session 3: July 14 - July 18All Sessions
T-shirt Size:
Child 4:
First Name Middle Name Last Name
Birth Date:

Month Day Year
Gender:

MaleFemale
Entering Grade:
School Attending:
T-shirt Size:
Session 1: June 30 - June 3Session 2: July 7 - July 11Session 3: July 14 - July 18All sessions
I am interested in: (Additional cost)

Early care (starting 8am)After care (Until 5pm)
Agreement:*

I give permission for my child's picture to be used in Camp Gan Izzy's marketing material, website and media.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.
2. Parent information
Phone Number:*

Area Code Phone Number

Address:*

Mother's info:*
First Name Last Name
Phone Number (Best way to reach you):*

Area Code Phone Number
E-mail:* Primary email
Father's info:*
First Name Last Name
Phone Number (Best way to reach you):*

Area Code Phone Number
E-mail:*
Was the child born Jewish?*

YesNo
Were there any conversions or adaptions in the family (parents, grandparents, children etc)?*

YesNo
If yes, please specify who converted?
How did you hear about us?
3. Emergency Information
Emergency Contact:*
First Name Last Name
Phone Number:*

Area Code Phone Number
Relationship:*
Pediatrician:
First Name Last Name
Phone Number:

Area Code Phone Number
Insurance:
Policy #:
4. Payment Information

Rate A - $340 per session (Actual cost)
Rate B - $270 per session (Subsidized)
For details regarding the different rates Click Here

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

5% Early Bird discount until March 1

Every Jewish child deserves a quality Jewish summer camp experience.
If you are in a position to donate to our scholarship fund Click Here

Need a scholarship?
Scholarships are available from the Feldman scholarship fund.
Contact us at 904-701- 4422
Choose your payment option

Rate ARate B
Non-refundable registration fee:

$0.00

Payment:*

Credit Card

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

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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1. Child/ren’s Information