Camp Registration Form

Child 1*

First NameLast NameHebrew Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Grade Entering

Weeks Attending*

Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20

Tshirt Size

Please indicate any medical, allergy, behavioral or IEP information

Child 2

First NameLast NameHebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Grade Entering

Weeks Attending

Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20

Tshirt Size

Please indicate any medical, allergy, behavioral or IEP information

Child 3

First NameLast NameHebrew Name

Birth Date

MonthDayYear

Gender

MaleFemale

Grade Entering

Weeks Attending

Week 1 July 2-6Week 2 July 9-13Week 3 July 16-20Full 3 Week Session July 2-20

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

Home Phone Number*

Area CodePhone Number

Home Address*

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

Mother's info*

First NameLast Name

Cell Phone*

Area CodePhone Number

Work Phone

Area CodePhone Number

E-mail*Primary email

Father's info

First NameLast Name

Cell Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

E-mail

How did you hear of us?*

Emergency Contact*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Payments*

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

Arizona Teacher Discount

I am a teacher and would love 30% off our camp fees

Total

$50.00

Payment*

Credit Card

Credit Card Type
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 is due upon registration and is non refundable. Camp cost is $175 per week. All fees must be paid by June 25th. The Early Bird Discount will be applied if registration and the $50 deposit is submitted by April 10, 2018. 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.

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information