Camp Registration

Camper Information

*Last Name

*First Name

Hebrew Name

*Gender

*Date of Birth

*Address

*City

*State

*Zip

Country

*Home Phone

*School

*Grade

Note

Medical Information

Physician Name

Physician Phone

Insurance

Insurance Number

Allergies

Medical Note

Parent Information

Father

Title

First Name

Last Name

Work Phone

Cell Phone

Mother

Title

First Name

Last Name

Work Phone

Cell Phone

*Marital Status

Emergency Information

Name Phone # Relation

*Emergency 1

Emergency 2

Enrollment Options / Tuition & Fees

Sessions

All Sessions (Save $)

1: 7/1/24 - 7/5/24

2: 7/8/24 - 7/12/24

3: 7/15/24 - 7/19/24

4: 7/22/24 - 7/26/24

Tuition

Extended Care

Lunch

Total Amount:

These fees will not be charged now. Only a $25 non refundable registration fee will be charged today. To pay your balance online by credit card please visit www.campganisraelscv.com/tuition. If you will be paying by check or need a payment plan plese indicate it in the "note" field above.

Payment Information

Only registration fee ($25) will be charged at this time.

Registration Fee

*Card Type

*Card Number

*Expiration Date

*Security Code

Use Information above

Name on Card

*Billing Address

*Billing Zip code

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Camp Gan Israel to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Camp Gan Israel personnel will try, but are not required, to communicate with me/us prior to such treatment.

I agree to the terms and conditions above

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