Camp Registration Form

1. Child/ren’s Information
Child 1*
First Name Last Name Hebrew Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Grade Entering
Weeks Attending*

Week 1 July 3-7Week 2 July 10-14Full 2 Week Session July 3-14
Tshirt Size*
Please indicate any medical, allergy, behavioral or IEP information
Child 2
First Name Last Name Hebrew Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering
Weeks Attending*

Week 1 July 3-7Week 2 July 10-14Full 2 Week Session July 3-14
Tshirt Size
Please indicate any medical, allergy, behavioral or IEP information
Child 3
First Name Last Name Hebrew Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering
Weeks Attending*

Week 1 July 3-7Week 2 July 10-14Full 2 Week Session July 3-14
Tshirt Size
Please indicate any medical, allergy, behavioral or IEP information
Early Care/After Care

8am - 9am l $20 a week per child3pm - 5:30pm l $45 a week per child
2. Parent information
Home Phone Number*

Area Code Phone Number

Home Address*

Mother's info*
First Name Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail* Primary email
Father's info
First Name Last Name
Cell Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail
How did you hear of us?*
3. Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
4. Payment Information
Payments*

Pay Deposit Only for 1 ChildPay Deposit Only for 2 ChildrenPay Deposit Only for 3 Children
Total

$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

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Agreement*

Application Information: Tuition fees & Refund policy: A $50 deposit per child is due upon registration and is non refundable. Camp cost - Weekly: Early Bird - $210, Regular - $240. Full Session: Early Bird - $395, Regular - $450. All fees must be paid by June 23rd. The Early Bird Discount will be applied if registration and the $50 deposit is submitted by May 8, 2023. 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.
Should be Empty:

1. Child/ren’s Information