מתוך האתר HamirkazPerth.org

Camp Gan Israel

fun forever!

Camp Register Form

1. Child/ren’s Information
Enter the message as it's shown*
Child 1*
First NameMiddle NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
$25 per day includes lunch*
Mon 9Tue 10Wed 11Thu 12Fri 13All week
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.
2. Parent information
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?
3. Emergency Information
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
4. Payment Information
Payment
$125 AUD$25 AUD$50 AUD$75 AUD$100 AUD

Payment

Credit Card Cheque/Cash

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
Should be Empty:

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