AUGUST 5-28*, 2025 (Aug 25-28 dependent on school start dates) IF YOU REGISTERED FOR SUMMER CAMP 2024, CLICK HERE TO USE THE EXPRESS CAMP REGISTRATION FORM Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. CGI is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative activities, to both provide enjoyment and inspire children to try new and exciting things! Camp Gan Israel is for children from ages 3-10, and LIT Girls for ages 11-12. For Dates & Rates & More info please click here 1. Child/ren’s Information How many children would you like to register for camp?* 1234 CHILD 1* First Name Last Name (1) Hebrew Name (1) Gender* MaleFemale (1) Birth Date* Month Day Year (1) Born after sunset This is to help determine the Jewish birthdate YesNo (1) School Attending (in the Fall)* (1) Grade (in the Fall)* (1) Can your child swim in deep water?* If you select Yes, we will still require your child to pass a swim test in order to swim in deep water. We will not give the test if you select No and your child will only be allowed to swim in the shallow sections YesNo (1) Are your child's immunizations up to date? (CGI requires all campers to be up to date with immunizations unless they have a medical exemption)* YesNo (1) Please specify if your child takes any prescription medication Please specify name of medication, dosage, time of dosage and any special instructions (1) Please specify if your child has any known allergies (1) Are there any medical or behavioral concerns that your child's counselor/s should be aware of? (1) Weeks* Week 1 - Aug. 4-8Week 2 - Aug. 11-15Week 3 - Aug. 18-22Week 4 - Aug. 25-28 CHILD 2 First Name Last Name (2) Hebrew Name (2) Gender MaleFemale (2) Birth Date Month Day Year (2) Born after sunset This is to help determine the Jewish birthdate YesNo (2) School Attending (in the Fall) (2) Grade (in the Fall) (2) Can your child swim in deep water? If you select Yes, we will still require your child to pass a swim test in order to swim in deep water. We will not give the test if you select No and your child will only be allowed to swim in the shallow sections YesNo (2) Are your child's immunizations up to date? (CGI requires all campers to be up to date with immunizations unless they have a medical exemption) YesNo (2) Please specify if your child takes any prescription medication Please specify name of medication, dosage, time of dosage and any special instructions (2) Please specify if your child has any known allergies (2) Are there any medical or behavioral concerns that your child's counselor/s should be aware of? (2) Weeks Week 1 - Aug. 4-8Week 2 - Aug. 11-15Week 3 - Aug. 18-22Week 4 - Aug. 25-28 CHILD 3 First Name Last Name (3) Hebrew Name (3) Gender MaleFemale (3) Birth Date Month Day Year (3) Born after sunset This is to help determine the Jewish birthdate YesNo (3) School Attending (in the Fall) (3) Grade (in the Fall) (3) Can your child swim in deep water? If you select Yes, we will still require your child to pass a swim test in order to swim in deep water. We will not give the test if you select No and your child will only be allowed to swim in the shallow sections YesNo (3) Are your child's immunizations up to date? (CGI requires all campers to be up to date with immunizations unless they have a medical exemption) YesNo (3) Please specify if your child takes any prescription medication Please specify name of medication, dosage, time of dosage and any special instructions (3) Please specify if your child has any known allergies (3) Are there any medical or behavioral concerns that your child's counselor/s should be aware of? (3) Weeks Week 1 - Aug. 4-8Week 2 - Aug. 11-15Week 3 - Aug. 18-22Week 4 - Aug. 25-28 CHILD 4 First Name Last Name (4) Hebrew Name (4) Gender MaleFemale (4) Birth Date Month Day Year (4) Born after sunset This is to help determine the Jewish birthdate YesNo (4) School Attending (in the Fall) (4) Grade (in the Fall) (4) Can your child swim in deep water? If you select Yes, we will still require your child to pass a swim test in order to swim in deep water. We will not give the test if you select No and your child will only be allowed to swim in the shallow sections YesNo (4) Are your child's immunizations up to date? (CGI requires all campers to be up to date with immunizations unless they have a medical exemption) YesNo (4) Please specify if your child takes any prescription medication Please specify name of medication, dosage, time of dosage and any special instructions (4) Please specify if your child has any known allergies (4) Are there any medical or behavioral concerns that your child's counselor/s should be aware of? (4) Weeks Week 1 - Aug. 4-8Week 2 - Aug. 11-15Week 3 - Aug. 18-22Week 4 - Aug. 25-28 If you have additional children please contact us. 2. Parents information Parents' Status* MarriedDivorcedSeparatedWidowedSingle Home Phone Number Area Code Phone Number Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country MOTHER'S NAME First Name Last Name E-mail* Primary email Cell Phone Area Code Phone Number Work Phone Area Code Phone Number Occupation FATHER'S NAME First Name Last Name E-mail Cell Phone Area Code Phone Number Work Phone Area Code Phone Number Occupation Synagogue Affiliation Who can we thank for referring you? Is the natural mother of the child/ren Jewish?* YesNo Is the natural father of the child/ren Jewish?* YesNo Were there any conversions or adoptions in the family? * YesNo If yes, please explain Are you interested in early care of after care? $45/week for Early Care and $40/week for After Care (no after-care on Fridays) AM (8:00-9:30)PM (3:30-5:00) 3. Emergency Contact Information Emergency Contact* Phone Number* Area Code Phone Number Relationship* Pediatrician Phone Number Area Code Phone Number In the event that I am not able to pick up my child, he/she may be released only to the following people: 4. Payment Information I will pay* We will automatically apply Additional Child Discount and Referral Bonus if applicable Full Tuition - $375/week ($300 for week 4).Subsidized Tuition - $325/week ($260 for week 4). Payment Option* ALL AT ONCE ($100 will be charged now and we will automatically charge the rest when we process the registration.)PAYMENT PLAN ($100 will be charged now and the rest will be divided in 2 equal payments on June 1 and July 1. If you need to set up a different payment plan, it must be coordinated with the Camp Director) Tuition Deposit to be charged now $100 Yes! I would like to sponsor another camper to enjoy Camp Gan Israel $375 covers 1 week of camp, $1235 covers a full summer $375$1235 Total $0.00 Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration Year Agreement* I am signing up my child for camp. I give my child permission to participate in all activities, attend all trips on camp-provided transportation and receive medical care in the case of emergency, G-d forbid. I release Camp Gan Israel at The Shul and individuals from liability in case of accident during activities related to Camp Gan Israel at The Shul, as long as normal safety procedures have been taken. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit. The parent/guardian who signs the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp tuition. I hereby acknowledge and declare that: I agree to indemnify, release, and hold harmless Shari & Alon Kaufman, from any cost, liability, claim, damages, demand arising from injury, loss, illness, or death to my children related to the use of the pool at 5400 Pontiact Trail, West Bloomfield, MI 48323. Likewise, any damage or loss to personal property caused by or related to the use of the Swimming Pool, its facilities, and its use. Further, I hereby indemnify, release, and hold harmless Shari & Alon Kaufman from any claims, demands, damages, and costs arising out of negligence resulting to loss, injuries, illnesses, or death. Finally, I recognize and fully understand and acknowledge the information above. By signing this form, I expressly declare that I am of legal age and that I am aware of the full contents of this waiver and I am legally accountable to any effects of this Release. Parent/Guardian's Signature* Comments I would like to receive news and updates by email Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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