CGI registration form

Full Name*

First Name Last Name

Hebrew name

Birth Date*

Month Day Year

Grade entering*

School attending*

Family Physician

First Name Last Name

Phone Number

Medicare number*

Expiration*

Allergies or health concerns

Select weeks you want your child to attend*

Sorry! Week one is fully booked!Week 2: July 6-July 10Week 3: July 13- July 17

Extended early and after care:

I'm interested in:

Week 1: Early care 8am-9am $5/day or $20/weekWeek1: After care 3:30pm-5pm $5/day or $20/weekWeek 2: Early care 8am-9am $5/day or $20/weekWeek 2 After care: 3:30pm-5pm $5/day or$20/weekWeek 3: Early care 8am-9am $5/day or $20/weekWeek 3: After care 3:30pm-5pm $5/day or $20/week

1 tshirt is included in tuition. Each additional t-shirt will be $10. Please select size for your child*

SmallMedLargeAdditional t-shirt

Parent status*

MarriedDivorcedWidowed

Mother Full Name*

First Name Last Name

Phone Number*

Address*

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

E-mail*

Father Full Name*

First Name Last Name

Phone Number*

E-mail*

Fill in address only if different than previous address.

Address

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

Contact 1*

First Name Last Name

Phone Number*

Relationship to the child*

Contact 2*

First Name Last Name

Phone Number*

Relationship to the child*

I authorize*

My child to participate in all Camp Gan Israel activities and tripsThe administration of Camp Gan Israel to take whatever medical measures they deem necessary for my child, in the event of a medical emergencyCamp Gan Israel to have and use photographs, slides and videos of the person named on this application as needed for educational and public relations programs

Parent

Date

Payment Details:
Rates per child: $250/week. Sibling discount: -10%
Tuition include lunches, snacks, all trips and 1 camp t-shirt
Registration closes Monday June 8th at 11:59 pm
All Payments need to be made by June 8, 2025
Any applications submitted after June 8th will inquire a $15 late processing fee per week.

Once your registration is processed, we will be sending you the payment method.

Total

$0.00

Register online - Please fill out the form below

Camper information

Enrollement options

Parent information

Emergency contact information

Permission

Services

Adult Education

Youth Programs

Holiday Celebrations

Women's Events

Community Services