Camp Gan Israel of Gilbert Summer 2017, July 3 - July 14 Registration Form Camper's information: Last name: First name: Hebrew name: Male Female Date of Birth: 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Age as of 6/20/16: Grade entering: Name of School: Any Jewish education please specify: T-shirt size: XS S M L XL Early Care 8am - 9am l $20 a week After Care 3pm - 5:30pm l $35 a week Camper #2: Last name: First name: Hebrew name: Male Female Date of Birth: 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Age as of 6/20/16: Grade entering: Name of School: Any Jewish education please specify: T-shirt size: XS S M L XL Early Care 8am - 9am l $20 a week After Care 3pm - 5:30pm l $35 a week Camper #3 Last name: First name: Hebrew name: Male Female Date of Birth: 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Age as of 7/1/15: Grade entering: Name of School: Any Jewish education please specify: T-shirt size: XS S M L XL Early Care 8am - 9am l $20 a week After Care 3pm - 5:30pm l $35 a week Parent's information: Father: Name: Home phone: Work phone: Cell phone: Email: Address: Mother: Name: Home phone: Work phone: Cell phone: Email: Address: Medical information: Currently taking these medications: Allergies: Child's doctor: Doctor's phone number: Emergency contact information: Emergency contact: Relation to camper: Home phone: Work phone: Cell phone: Comments: Payment information: Click here for dates and rates I'm registering 1 2 3 4 5 6 7 8 9 child/ren for camp. Please charge my credit card $50 deposit for each child. (deposit is applied to camp fees) Additionally please charge my credit card towards my child/rens session/s Yes! Please add a donation of to the CGI Scholarship Fund I'm paying by check or cash (Make checks payable and mail to Chabad of Gilbert 4475 E. Carriage Way, Gilbert AZ 85297) Card number: CVV security code: Expiration: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year: 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Card zip code Email confirmation to: Register by May 12, 2017 and save $25 a week on your camp fees. Application Information: Tuition fees & Refund policy: A $50 deposit is due upon registration and is non refundable. Your child's place is secured upon receipt of the $50 deposit. Camp cost is $165 per week. All fees must be paid by June 26th. A discount of $25 per week will be applied if registration and the $50 deposit is submitted by May 12, 2017. Permissions: I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation. My child has permission to participate in any field trip or activity done with Camp Gan Israel of Gilbert. Camp Gan Israel will make every effort to insure the well-being of every camper. However, it will not be responsible for any injury or health impairment of any camper. Gan Israel will not be responsible for damage to or loss of clothing or personal belongings. I allow Camp Gan Israel to use my child(ren)’s photograph for all promotional purposes. In the event of an emergency, illness, or accident, Camp Gan Israel has my permission to arrange any necessary first-aid or care by a paramedic or licensed physician for my child/ren while he/she is attending camp. I agree to all the terms & information listed herein. Signature of parent or legal guardian This page uses 128 bit SSL encryption to keep your data secure.