Summer Camp 2022 Application Form

CAMP GAN ISRAEL APPLICATION FORM
SUMMER 2022 - 5782
COVID-19 Update:
Please note that there may be changes to this year's camp program, schedule and safety precautions due to changing guidelines and regulations.
Campers Information
Family Name:*
English Name:*
Hebrew Name:
Gender:*
Date of Birth*
MonthDayYear
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
Payment Schedule
Subsidy

Payment Type*

Credit Card I Will Send A Cheque

Please enter any comments you have here:
Click the button below to submit your child's application. Please note that your child's participation is not guaranteed until you receive a confirmation email from camp.
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Campers Information