Registration Form

Child's Full Name*

First Name Last Name

Age of Child*

Child's Birth Date*

Month Day Year

Child's Home Language

Grade Entering Fall 2026

First Parent or Legal Guardian*

Relationship to Child

Daytime Phone Number*

Home Phone Number

Full Mailing Address

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

E-mail*

Second Parent or Legal Guardian

Relationship to Child

Full Mailing Address

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

Daytime Phone Number:

Home Phone Number

Second Parent or Legal Guardian E-mail

Emergency Contact Name*

Emergency Contact Full Mailing Address*

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

Daytime Phone Number*

Home Phone Number*

Emergency Contact #2*

First Name Last Name

Full Mailing Address*

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

Daytime Phone Number*

Home Phone Number*

E-mail*

Pediatrician Name*

Pediatrician phone number*

Dentist Name*

Dentist Number*

Allergies*

Additional Permissions:

Usage of your child's photo internally (bulletin board, camp newsletter)Usage of your child's photo externally (website, social media)Permission to attend field tripsPermission to ride the yellow school bus or the larger rented white bus, only driven bu a driver with a certified CDLI understand that every effort will be made to contact me in case of an emergency. If I am not able to be reached during a medical emergency, I hereby authorize Camp Gan Israel to obtain emergency medical care for my child. In addition, if my child requires emergency medical transportation, I authorize my child to be transported.

Please describe any medication that your child will need to take during camp hours. There will be a separate permission form required for this.

Child's T-Shirt Size*

SmallMediumLargeExtra-large

Week One

$400 Summer Camp (June 29 - July 3rd)$65 Food Program$50 Early Care$75 Late Care

Week Two

$400 Summer Camp (July 6 - July 10)$65 Food Program$50 Early Care$75 Late Care

Week Three

$400 Summer Camp (July 13-17)$65 Food Program$50 Early Care$75 Late Care

Week Four

$400 Summer Camp (July 20 - 24)$65 Food Program$50 Early Care$75 Late Care

Week Five

$400 Summer Camp (July 27- July 31)$65 Food Program$50 Early Care$75 Late Care

Did you receive a scholarship? More information for available options are listed on the "Fees & Financial Assistance" page on the camp website

YesNo

Please name the scholarship you received and the amount of money allocated to your child (in the comment box below). If you are still in the application process and unsure of the amount yet, please email us once it has been confirmed and we will adjust your total and send the invoice at that time.

Comments (If relevant, please note if you are in the process of applying for a scholarship or if you have already received a confirmation)

Total

$0.00

I would like to pay today:Full amount$0.00 minimum$

Yes, I'd like to donate the cost of processing this transaction by adding 3.4%

Payment Options

Credit Card eCheck Venmo

Postal / Zip Code

Country

Child's Information

Parent/ Legal Guardian Information

Emergency Contact Information

Health and Permissions

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