AUGUST 3-20, 2026 THIS EXPRESS FORM IS ONLY FOR CAMPERS THAT REGISTERED FOR CGI SUMMER 2025. IF YOU DID NOT, PLEASE USE THIS 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 (boys ages 3-8), and LIT Girls for ages 11-12. Stay tuned for possible Pioneer Boys division for ages 9-12. 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 Same school and following grade as last year?* Yes 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 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)* YesNo 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? Weeks * Week 1 - Aug. 3-7Week 2 - Aug. 10-14Week 3 - Aug. 17-20 CHILD 2 First Name Last Name Same school and following grade as last year? Yes 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 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)* YesNo 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? Weeks * Week 1 - Aug. 3-7Week 2 - Aug. 10-14Week 3 - Aug. 17-20 CHILD 3 First Name Last Name Same school and following grade as last year? Yes 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 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)* YesNo 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? Weeks * Week 1 - Aug. 3-7Week 2 - Aug. 10-14Week 3 - Aug. 17-20 CHILD 4 First Name Last Name Same school and following grade as last year? Yes 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 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)* YesNo 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? Weeks * Week 1 - Aug. 3-7Week 2 - Aug. 10-14Week 3 - Aug. 17-20 If you have additional children please contact us. 2. Parents information Parents' Status* MarriedDivorcedSeparatedWidowedSingle Same address as last year? Yes Same phone numbers as last year? Yes MOTHER'S NAME First Name Last Name E-mail* Primary email FATHER'S NAME First Name Last Name E-mail Are you interested in early care or after care? $75/week for Early Care and $60/week for After Care (no after-care on Fridays) AM (8:00-9:30)PM (3:30-5:00) 3. Emergency Contact Information 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* Subsidized Tuition - $350/week ($280 for week 3). (Not applicable for LIT Girls Division)Full Tuition - $400/week ($320 for week 3). Payment Option* PAYMENT PLAN ($100 will be charged now and we schedule the balance to be paid in 2 equal installments on June 1 and July 1)ALL AT ONCE ($100 will be charged now and we will automatically charge the rest when we process the registration) Tuition Deposit to be charged now minimum $100 required now $100 Yes! I would like to sponsor another camper to enjoy Camp Gan Israel $375 covers 1 week of camp, $1050 covers all 3 weeks $375$1050 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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