Camp Registration

Experience the summer of your lifetime!
Please note, in order for your child to be officially enrolled a payment must be received or a payment plan worked out. Thank you for your understanding!
Childs Information:
Full Name:*
First Name: Last Name:
Hebrew Name: *
Gender:*

MaleFemale
Grade entering in September:*
Birth Date*

Month Day Year
Time of Day:*
Hour Minutes
Family Information:

Address:*

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

Home Phone Number: *

Area Code Phone Number
Father's Name:*
Father's Birth Date:*

Month Day Year
Hebrew Name:*
Father's E-mail:*
Cell Phone Number:*

Area Code Phone Number
Mother's Name: *
Mothers Hebrew Name:*
Mother's Birth Date:*

Month Day Year
Mother's E-mail:*
Cell Phone Number:*

Area Code Phone Number
Marital Status:*

MarriedSingleDivorced
Was the natural mother of the child born Jewish?*

YesNo
Is the natural father of the child Jewish?*

YesNo
Was the maternal grandmother of the child born Jewish?*

YesNo
Are there any conversions and/or adoptions in the family?*

YesNo
Conversion Type:
Medical Information:
Is there any special medical or other information that we should be aware of?*

YesNo
If yes, please describe:
Does your child have any allergies?*

YesNo
Is your child currently taking any medication?*

YesNo
Family Physician:*
Emergency Contact #1:*
Relation: *
Phone Number:*

Area Code Phone Number
Medical Release:*

I hereby give consent to the administration of the Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Permission Slips:*

I hereby give permission to my child to participate in all outings and field trips beyond camp properties and to use any transportation selected by the Gan IsraelI grant permission for my child to be photographed in individual or group pictures which may be used by Camp Gan Israel for P.R.
Payment Information:
For your convenience, you can now pay for Camp online! This page uses a secure connection and your information will not be shared with anyone. If you are in need of financial assistance please call our office at (407) 644-2400 Ext.#1. Early bird ends MAY 10TH
I am registering my child:* Fee is non-refundable

Registration fee: $25
Payment Options:* Early Bird ends May 10th.
Morning Extra Care:* 8:30 AM - 9:30 AM

1 week: $502 week: $100I won't be needing
Afternoon Extra Care:* 3:30 PM - 4:30 PM

1 week: $502 week: $100I won't be needing
Camp T-Shirt and Cap:* Please note: Caps are only for the regular division
David would love to attend a Jewish summer camp. Unfortunately his parents can't afford to send him. Please open up your hearts and wallets a little bit more to sponsor David. Every dollar helps! Thank you in advance!
Yes! I would love to help out!

Sponsor David for 2 weeks: $420Sponsor David for 1 week: $230Sponsor Davids friend: $420
Total:

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment:

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Childs Information:

Family Information:

Medical Information:

Payment Information: