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 NameMiddle NameLast Name
Birth Date:*
MonthDayYear
Gender:*
MaleFemale
School Attending:
Entering Grade:
T-shirt Size:*
Each session- $215
10% Early Bird discount until February 1
Cost includes registration fee, camp T-shirt, all camp activities and trips
Need a campership? Call Rabbi Mendel or Dini 904-701-4422
Registration:*
Session 1: June 20 - June 24Session 2: June 27 - July 1Session 3: July 4 - July 8All Sessions
Child 2:
First NameMiddle NameLast Name
Birth Date:
MonthDayYear
Gender:
MaleFemale
School Attending:
Entering Grade:
Session 1: June 20 - June 24Session 2: June 27 - July 1Session 3: July 4 - July 8All Sessions
T-shirt Size:
Child 3:
First NameMiddle NameLast Name
Birth Date:
MonthDayYear
Gender:
MaleFemale
Entering Grade:
School Attending:
Session 1: June 20 - June 24Session 2: June 27 - July 1Session 3: July 4 - July 8All 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 20 - June 24Session 2: June 27 - July 1Session 3: July 4 - July 8All sessions
I am interested in:(additional cost)
Early care (starting at 8am)After care (until 5pm)
2. Parent information
Phone Number:*
Area CodePhone Number

Address:*

Mother's info:
First NameLast Name
Phone Number (Best way to reach you):
Area CodePhone Number
E-mail:Primary 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?
3. Emergency Information
Emergency Contact:*
First NameLast Name
Phone Number:*
Area CodePhone Number
Relationship:*
Pediatrician:
First NameLast Name
Phone Number:
Area CodePhone Number
Insurance:
Policy #:
4. Payment Information
Each session- $215
10% Early Bird discount until February 1,
Cost includes registration fee, camp T-shirt, all camp activities and trips
Need a campership? Call Rabbi Mendel or Dini 904-701-4422
Non-refundable registration fee:
$0.00

Payment:

Credit Card

Please charge my balance:*
Via CC above.
Agreement:*
I give permission for my child's picture to be used in Camp Gan Israel'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.
General comments:
Should be Empty:

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1. Child/ren’s Information