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One Day CGI Registration

One Day Camp

Monday, January 15

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*

MaleFemale
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
No camper will be turned away due to lack of funds.
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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