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CGI Winter Camp Registration

Winter Camp

Monday, December 19 - Friday, December 23

Choose any days you'd like to join!

9:00am-3:00pm

Kids Ages 2-12
1. Camper Information
Name*

First Name Last Name
My child is a*
Hebrew Name
Birth Date*

Month Day Year
Gender*

Male Female
2. Parents information

Address*

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

Mother's Name

First Name Last Name
Mother's Hebrew Name
Cell Phone

Area Code Phone Number
E-mail Primary email
Farther's Name

First Name Last Name
Father's Hebrew Name
Cell Phone

Area Code Phone Number
E-mail Primary email
3. Emergency Information
Emergency Contact*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician

First Name Last Name
Phone Number

Area Code Phone Number
Important Medical Information or Other Notes
4. Payment Information
My child will be attending:
Mark each day attending*

Mon. Dec. 19 Tues. Dec. 20 Wed. Dec. 21 Thurs. Dec. 22 Fri. Dec. 23
No camper will be turned away due to lack of funds. For scholarships, please contact Shainy Greenberg at [email protected]
Total

$0.00

Payment

Credit Card Paypal I will send in a check

Postal / Zip Code

Country

Agreement*

I am signing up my children for camp. I give my children permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I agree that Camp Gan Israel, its administration and staff, will not be liable for any injury or health impairment that may occur.
Agreement*

I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without using their names) as camp sees fit.
Comments
I would like to receive news and updates by email
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