Camp Gan Israel Summer 2019 July 1st - July 26th Boys and Girls Ages 4-12 Mini-Gan - Ages 2- 3 Week 1 - July 1 - July 5 (No camp July 4) Week 2 - July 8 - July 12 Week 3 - July 15 - July 19 Week 4 - July 22 - July 26 Parent's Information Mother's Name Father's Name Address 1 Address 2 City State/Zip Home phone E-mail Mother's Cell Father's Cell Mother's Work Father's Work Camper's Information Camper 1: Name Hebrew name Date of birth Age Grade Previous Hebrew Education Camper 2: Name Hebrew name Date of birth Age Grade Previous Hebrew Education Camper 3: Name Hebrew name Date of birth Age Grade Previous Hebrew Education My child will attend: All 4 Weeks Week of: Week 1 Week 2 Week 3 Week 4 Any medical or other information regarding your child we should be aware of: Emergency Contact Name Relationship Phone Name Relationship Phone I herby permit my child to participate in all CGI activities. I also permit my child to join all trips beyond the program property. In case of emergency I hereby authorize the CGI Program to have my child taken care of by a physician in any way the situation may call for. Payment Information Payment Info: $150 per week plus $10 (t-shirt) Payment Method CC check/other Total $ Card Type Please Select Visa Mastercard American Express Card Number Expiration Date CVV Billing Address: IF DIFFERENT FROM ADDRESS ABOVE Address Address 2 City/State/Zip Comments This page uses 128 bit SSL encryption to keep your data secure.
