Camp Gan Israel

Summer 2018

June 25th - July 20th

Boys and Girls Ages 4-12

Mini-Gan - Ages 2- 3

Week 1 - June 25 - June 29

Week 2 - July 2- July 6  (No camp July 4th)

Week 3 - July 9 - July 13

Week 4 - July 16  - July 20

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
Card Number Expiration Date
CVV
Billing Address: IF DIFFERENT FROM ADDRESS ABOVE
Address Address 2 City/State/Zip
Comments