Summer Camp 2021 Registration Form

Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. CGI is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative activities, to both provide enjoyment and inspire children to try new and exciting things!

Child 1*

First Name Middle Name Last Name

Jewish/Hebrew Name:

Age*

Grade* Fall 2021

Birth Date*

Month Day Year

Gender*

Male Female

Select Camp Sessions

Session 1 - June 21 - 25 - "On the Lake" Session 2 - June 28 - July 2 - "Mountains and More" Session 3 - July 5 - 9 "At the Beach'" Session 4 - July 12 -16 "Farm Life" Session 5 - July 19 - 23 "Gone Camping" Session 6 - July 26 - 30 "By the Riverside"

Early Care / After Care

Early Care 7:30-8:30 AM After Care 3:30-5:30 PM

Child 2

First Name Middle Name Last Name

Jewish/Hebrew Name:

Age

Grade Fall 2021

Birth Date

Month Day Year

Gender

Male Female

Select Camp Sessions

Session 1 - June 21 - 25 - "On the Lake" Session 2 - June 28 - July 2 - "Mountains and More" Session 3 - July 5 - 9 "At the Beach'" Session 4 - July 12 -16 "Farm Life" Session 5 - July 19 - 23 "Gone Camping" Session 6 - July 26 - 30 "By the Riverside"

Early Care / After Care

Early Care 7:30-8:30 AM After Care 3:30-5:30 PM

Child 3

First Name Middle Name Last Name

Jewish/Hebrew Name:

Age

Grade Fall 2021

Birth Date

Month Day Year

Gender

Male Female

Select Camp Sessions

Session 1 - June 21 - 25 - "On the Lake" Session 2 - June 28 - July 2 - "Mountains and More" Session 3 - July 5 - 9 "At the Beach'" Session 4 - July 12 -16 "Farm Life" Session 5 - July 19 - 23 "Gone Camping" Session 6 - July 26 - 30 "By the Riverside"

Early Care / After Care

Early Care 7:30-8:30 AM After Care 3:30-5:30 PM

If you have additional children please use the general comments section below.

IF YOU ARE LOOKING TO REGISTER PER DAY PLEASE CHOOSE "DROP IN" DATES BELOW OTHERWISE SKIP THIS SECTION."Drop in" option is $65/day.Please select the days you wish to "drop in" below:

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Mother's info*

First Name Last Name

Cell Phone*

Area Code Phone Number

Work

Area Code Phone Number

E-mail* Primary email

Occupation

Address*

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

Father's info*

First Name Last Name

Cell Phone*

Area Code Phone Number

E-mail

Occupation

Address (if different than above)

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

How did you hear of us?

Are the natural parent's of the child/ren Jewish?*

Mother Father Neither

Did Mother convert to Judaism?

Yes No

Medical Information Are there any medical conditions/allergies or pertinent information regarding your child, which we should be aware of?

Emergency Contact* other than parent

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship*

Pediatrician & Insurance

First Name Last Name

Phone Number

Area Code Phone Number

Insurance

Policy #

Non-refundable registration fee*

1 Camper $50 2 Campers $100 3 Campers $150

A non-refundable registration fee applies as part of this registration.

Total

$0.00 USD

Payment* Registration will not be secured until full payment is made. We accept cash, check. zelle, venmo or cashapp.


Camp payments must be made before your child/ren's first day of camp.

Agreement*

I hereby permit my child/ren to participate in all camp activities and join in camp trips on and beyond camp properties. In case of emergency, I hereby authorize the CGI to have my child taken care of by a physician in any way the situation may call for. I hereby agree to pay the camp fees.

General comments

Summer Camp 2021 Registration Form

1. Child/ren’s Information

2. Mother

Father

3. Emergency Information

4. Payment Information

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