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Pre-Camp Covid Screening
For All Parents/Guardians of Campers Attending The Summer Of 2020

This Form Must Be Complete By June 29th. In order for campers to attend camp on the first day all parents must be tested for Covid-19. Testing will take place at The Shul Center on July 5th from 12-3pm by the medical staff of Shalem Healing and Dr. Rob Fox.

1.  Parent/Guardian Name: [Last, First] 

   DOB:  
   Phone Number:
  Address
  City/State/Zip
  Name Of Insurance
  Insurance ID#
  Full Name Of Primary Insurance Holder
 
   I currently do not have health insurance.

 

2.  Parent/Guardian Name: [Last, First] 

   DOB:  
   Phone Number:
  Address
  City/State/Zip
  Name Of Insurance
  Insurance ID#
  Full Name Of Primary Insurance Holder
 
   I currently do not have health insurance.

 


 

  Yes!  Due to the ever changing health climate I understand the importance of a pre-camp Covid-19 screening. 

 

 I understand that my child will not be able to attend Camp Gan Israel Milwaukee(CGI) if I do not complete a Covid-19 screening 24 hours before the start of camp and the results of said test are negative. 

 I will attend the Covid-19 screening for CGI parents/guardians only that will take place at the Shul Center on July 5th from 12-3pm. If I am unable to attend at that time I will contact the camp office to make other arrangements. 

 I give permission for CGI to share the information in this form with the medical staff at Shalem Healing. 

 I understand that the results of my Covid-19 screen will be shared with me and Camp Gan Israel by the medical staff at Shalem Healing. Furthermore, if I arrange testing at a different site, I understand I need to share my Covid-19 screening results with CGI in order for my child(ren) to attend camp. 

Our family will be opting out of the Covid-19 screening and will NOT be attending camp this summer.
  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:

 

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Camp Gan Israel • Milwaukee, WI 53217 • 414-228-8372
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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