Summer Camp 2024 Application Form

CAMP GAN ISRAEL REGISTRATION FORM

NOTE: Click here for the short form for returning campers
Campers Information
Family Name:*
English Name:*
Hebrew Name:
Gender:*
Date of Birth*

Month Day Year
School:
Grade Before Summer:
Contact Information
Child is in care of:
Best contact phone:
Address:
City:
Postal Code:
Father's Information
English Name:
Hebrew Name:
Father is:
Home Phone:
Cell Phone:
Work Phone:
E-mail
Mother's Information
English Name:
Hebrew Name
Mother is:
Home Phone:
Cell Phone:
Work Phone:
E-mail
Emergency contact other than parent/guardian
Emergency contact name:
Relationship
Phone
Medical Information
Family Medical Number:*
(6 digit)
Camper's Personal Health ID:*
(9 digit)
Camper's Doctor:
Doctor's Tel #:
Doctor's Address:
Describe any medical information the camp should be aware of, such as allergies, medications, or any other concerns or special needs of your child:
Program Information
Sessions Attending:
Extra Care
Camp T-Shirt size Mandatory for trip days
sizes are approximate
T-Shirt Quantity $15 each
Payment Schedule
Subsidy no subsidy for extra care or t-shirts

Payment Type*

Credit Card I Will Send A Cheque

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Campers Information