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Summer Camp Registration

IF YOU REGISTERED FOR SUMMER CAMP 2022, 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!

For Dates & Rates & More info please click here
1. Child/ren’s Information
How many children would you like to register for camp?*
CHILD 1*

First Name Last Name
Hebrew Name
Gender*

Male Female
Birth Date*

Month Day Year
Born after sunset This is to help determine the Jewish birthdate

Yes No
School Attending (currently)*
Finishing Grade (currently)*
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

Yes No
Weeks*

Week 1 - Aug. 7-11 Week 2 - Aug. 14-18 Week 3 - Aug. 21-24
CHILD 2

First Name Last Name
Hebrew Name
Gender

Male Female
Birth Date

Month Day Year
Born after sunset This is to help determine the Jewish birthdate

Yes No
School Attending (currently)
Finishing Grade (currently)
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

Yes No
Weeks

Week 1 - Aug. 7-11 Week 2 - Aug. 14-18 Week 3 - Aug. 21-24
CHILD 3

First Name Last Name
Hebrew Name
Gender

Male Female
Birth Date

Month Day Year
Born after sunset This is to help determine the Jewish birthdate

Yes No
School Attending (currently)
Finishing Grade (currently)
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

Yes No
Weeks

Week 1 - Aug. 7-11 Week 2 - Aug. 14-18 Week 3 - Aug. 21-24
CHILD 4

First Name Last Name
Hebrew Name
Gender

Male Female
Birth Date

Month Day Year
Born after sunset This is to help determine the Jewish birthdate

Yes No
School Attending (currently)
Finishing Grade (currently)
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

Yes No
Weeks

Week 1 - Aug. 7-11 Week 2 - Aug. 14-18 Week 3 - Aug. 21-24
If you have additional children please contact us.
2. Parents information
Parents' Status*

Married Divorced Separated Widowed
Home 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
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
How did you hear of us?
Who can we thank for referring you?
Is the natural mother of the child/ren Jewish?*

Yes No
Were there any conversions or adoptions in the family?*

Yes No
If yes, please explain
Are you interested in early care of after care? $35/week for AM and $30/week for PM (no after-care on Fridays)

AM (8:00-9:30) PM (3:30-5:00)
Would you be interested in a Bonus Trip Camp the week of August 28?

Yes No Maybe
3. Medical & Emergency Information
Are your child(ren)'s immunizations up to date? (CGI requires all campers to be up to date with immunizations unless they have a medical exemption)*

Yes No
Please specify if your child takes any prescription medication Please specify name of medication, dosage, time of dosage and any special instructions
Please specify if your child has any known allergies
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
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

A minimum $100 deposit is due as part of this registration
I will pay* We will automatically apply Additional Child Discount, First 20 Campers Bonus and Referral Bonus if applicable

Full Tuition - $350/week ($300 for week 3) Subsidized Tuition - $300/week ($250 for week 3)
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 remaining tuition will be charged in 2 installments on June 2nd and July 2nd. If you need to set up a different payment plan, it must be coordinated with the Camp Director)
Tuition Deposit to be charged now minimum $100 required now

$100
Yes! I would like to sponsor another camper to enjoy Camp Gan Israel $350 covers 1 week of camp, $1000 covers a full summer

$350 $1000
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

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.
Parent/Guardian's Signature*
Comments
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Camp Gan Israel

at The Shul

1. Child/ren’s Information

2. Parents information

3. Medical & Emergency Information

4. Payment Information

Camp Address