CAMP GAN ISRAEL REGISTRATION FORM NOTE: Click here for the short form for returning campers Campers Information Family Name:* English Name:* Hebrew Name: Gender:* Boy Girl Date of Birth* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School: Grade Before Summer: Contact Information Child is in care of: Parents Mother Father Guardian Best contact phone: Address: City: Postal Code: Father's Information English Name: Hebrew Name: Father is: Jewish Not Jewish Home Phone: Cell Phone: Work Phone: E-mail Mother's Information English Name: Hebrew Name Mother is: Jewish Not Jewish 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: Full Camp (July 4- July 28) $700 First Session (July 4- July 14) $400 Second Session (July 17 - July 28) $400 Other - see comment below Extra Care Not Needed A.M. (8:30-9:30) > add $30/week P.M. (4:00-5:00) > add $30/week Both a.m. & p.m. > add $60/week Camp T-Shirt size Mandatory for trip days Please select Youth Extra Small (size 2/4) Youth Small (size 6/8) Youth Medium (size10/12) Youth Large(size 14/16) Adult Small Adult Medium Adult Large Adult Extra Large sizes are approximate T-Shirt Quantity $15 each Already own 1 2 3 4 Payment Schedule Pay the total fee now $150 application deposit. balance to be paid by July 4th other, please see comment below Subsidy I am able to pay the regular price I require the subsidized price (20% off) Other (please use comment box below) Payment Type* Credit Card I Will Send A Cheque Credit Card We accept Visa, MasterCard Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Please enter any comments you have here: Submit Clear Form Should be Empty: This page uses TLS encryption to keep your data secure.