Camp Register Form

Enter the message as it's shown*

Child 1*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

$35 per day includes lunch*

Child 2

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child 3

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child 4

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

If you have additional children please contact us.

Phone Number*

Area CodePhone Number

Address*

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

Mother's info

First NameLast Name

Work Phone

Area CodePhone Number

E-mailPrimary email

Mobile

Area CodePhone Number

Father's info

First NameLast Name

Work Phone

Area CodePhone Number

E-mail

Mobile

Area CodePhone Number

How did you hear of us?

Emergency Contact*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Payment

Agreement*

I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

General comments

Camp Register Form

Camp dates 6-10 July

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information