Register by March 15th and receive 15% or by April 15th for 10% off your family's tuition!

To enroll in the Discoverer's Division of camp (ages 6 weeks - 4), please  click here  for their form.

We need this form filled out COMPLETELY and SIGNED before any child can be fully registered.


PARENT INFORMATION

Mother's Name
Address City/State/Zip
Cell Phone Home Phone
Work Phone Email Address




Father's Name Same address
Address City/State/Zip
Cell Phone Home Phone
Work Phone Email Address


1. Camper's Name: [Last, First]  

  Gender & DOB: M F
  Grade [Fall 2021]:     School Attending [Fall 2021]:
  Sessions:  Weeks:
  Extended Care: Available: 7:30am-5:30pm for additional fee. Please sign up for extended care on our Pre-Pay Form. [Click here to go directly to the Pre-Pay form.]
  Age:
MEDICAL HISTORY
Please note: you must also fill out a Medical History and Emergency Care form for each child.
  In the past six months, has your child had any serious illnesses?
No Yes. If yes, please list
:
  In the past six months, has your child been on any medications?
No Yes. If yes, please list
:
  Does your child receive individualized assistance in school?
No Yes. If yes, please describe:

**If you are only registering one camper, please skip to "Transportation Information"**

2. Camper's Name: [Last, First] 

  Gender & DOB: M F
  Grade [Fall 2021]:   School Attending [Fall 2021]:
  Sessions:  Weeks:
  Age:
MEDICAL HISTORY
Please note: you must also fill out a Medical History and Emergency Care form for each child.
  In the past six months, has your child had any serious illnesses?
No Yes. If yes, please list
:
  In the past six months, has your child been on any medications?
No Yes. If yes, please list:
  Does your child receive individualized assistance in school?
No Yes. If yes, please describe:

3. Camper's Name:[Last, First]  

  Gender & DOB: M F   
  Grade [Fall 2021]:     School Attending [Fall 2021]:
  Sessions:    Weeks:
  Age:
MEDICAL HISTORY
Please note: you must also fill out a Medical History and Emergency Care form for each child.
  In the past six months, has your child had any serious illnesses?
No Yes. If yes, please list:
  In the past six months, has your child been on any medications?
No Yes. If yes, please list:
  Does your child receive individualized assistance in school?
No Yes. If yes, please describe:

TRANSPORTATION INFORMATION

  Please let us know who, other than yourself, has permission to pick up your child from camp: [Please note: Your child will not be released to anyone not on this list]:
 

EMERGENCY CONTACT INFORMATION

Please list at least one emergency contact other than the child's parents.

1. Emergency Contact Name [other than parents]
  Relationship to Child
  Address City/State/Zip
  Home Phone Other Phone
2. Emergency Contact Name [other than parents]
  Relationship to Child
  Address City/State/Zip
  Home Phone Other Phone
 

Physician Contact Information

  Name of Child's Physician or Medical Facility
  Phone Address

IMPORTANT INFORMATION
 

Deposit is $150 per child. I understand that my deposit is non-refundable, that full payment is due by June 1st, at which time the balance of tuition becomes non-refundable, and that refunds will not be made for incomplete attendance. The parent/guardian who submits this registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fees.

  I agree to the above terms.
PAYMENT INFORMATION
  Name on Card
  Total Deposit Amount
  Credit Card #
  Card Type/Exp. Date
  CCV Number

REGISTRATION POLICIES AND PARENTAL CONSENT

 

I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation and to obtain emergency medical care as the situation mandates.

It is my responsibility to apply sunscreen on my child(ren) every morning before camp and to send along a labeled bottle for reapplication. However, in case of emergency, Rocky Mountain SPF 30 sunscreen is provided.

I am giving my permission for my child(ren) to participate in any pontoon/speed boating, horseback riding, ropes course, field trips, overnight trips and any other activity that is scheduled on the CGI calendar for his or her age group.

I allow Camp Gan Israel to photograph and/or videotape my child(ren) and to use these images for all promotional purposes.

I understand that my deposit is non-refundable and that full payment or payment plan must be set up by June 1st, at which time the balance of tuition becomes non-refundable, and that refunds will not be made for incomplete attendance. In addition, I understand that sending in a deposit does not guarantee me a spot in camp, and that acceptance into Camp Gan Israel is at the discretion of the camp.

The parent who signs this registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fees.

  By typing my name and the date below, I certify that the information on this application is true and correct and that I have read, and approve, the policies listed above.
  Your Name:  Date: