Winter Camp Registration Form 2022

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*

Birth Date*

Month Day Year

Gender*

Male Female

Select Camp Days* Preschool camp is Day 6-10 ONLY

Aftercare (not available Fridays)) 3:30 - 5:30 pm Not available for preschoolers.

Child 2

First Name Middle Name Last Name

Jewish/Hebrew Name:

Age

Birth Date

Month Day Year

Gender

Male Female

Select Camp Days Preschool camp is day 6-10 ONLY.

Aftercare (not available Fridays)) 3:30 - 5:30 pm Not available for preschoolers.

Child 3

First Name Middle Name Last Name

Jewish/Hebrew Name:

Birth Date

Month Day Year

Age

Gender

Male Female

Select Camp Days

Aftercare (not available Fridays)) 3:30 - 5:30 pm

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

The Following Info. is for New Campers ONLY

Mother's info

First Name Last Name

Cell Phone

Area Code Phone Number

Work

Area Code Phone Number

E-mail Primary email

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

Address (if different than above)

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

How did you hear about our camp?

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 #

Total

$0.00 USD

Payment*


We accept Venmo, Zelle or Cash App. For Check or Cash please pay at the door.

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

Winter Camp Registration Form 2022

1. Child/ren’s Information

2. Mother

Father

3. Emergency Information

4. Payment Information

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