Camp Registration

CAMP GAN ISRAEL WINTER CAMP
DECEMBER 23RD & 24TH • 10:00am-3:00pm
Why wait for summer to experience the excitement of Camp Gan Israel?!
Bring the fun of Gan Izzy right into your winter break!
Camp activities include: games, cooking, outdoor fun, crafts, sports, awesome Chanukah and CGI activities, hunts and more!!
For Jewish children Ages 5-12

Child 1*

First Name Last Name

Hebrew name

Age*

Birth Date*

Month Day Year

Gender*

Male Female

Child 2

First Name Last Name

Hebrew name

Age

Birth Date

Month Day Year

Gender

Male Female

If you have additional children please contact us.

Phone Number

Area Code Phone Number

Address*

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

Mother's Name*

First Name Last Name

Cell Phone*

Area Code Phone Number

E-mail Primary email

Farther's Name*

First Name Last Name

Cell Phone*

Area Code Phone Number

E-mail Primary email

How did you hear of us?

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

Amount

$60 USD $120 USD

Total

$0.00 USD

Payment*

Credit Card Other

Postal / Zip Code

Country

Agreement*

I am signing up my child for camp. My child/ren may attend all outings and receive medical care in the case of emergency.

Comments

I would like to receive news and updates by email

Winter Camp Registration

1. Child/ren’s Information

2. Parents information

3. Emergency Information

4. Payment Information