Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Please Click Here to Download Our Health Form  

Camper/Parent Information
Name
  First
Middle Last  
Address
  Street
City State
Zip
Date of Birth
   
Contact Info
  Phone
Email
 
Schools
  School
Hebrew School Entering Grade:
Child's Mother
  Mother's Name
Hebrew Name Work Phone Cell
Child's Father
  Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
  Name
Phone Relationship  
Pediatrician
  Name
Phone    

Email

     
           
Select Child's Age Group
Ages 10-12
Ages 3-4  
Ages 5-9
 
   
 
 
Please indicate number of sessions your child will attend camp including if you need extended care for Mini Gan:
 
   
     
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Check Mastercard Visa Amex Discover
I give my child permission to attend all trips, and receive medical care in the case of emergency.
   

  

PAYMENT INFORMATION:  $225/WEEK FOR CAMP GAN ISRAEL |
*Last Name   Charge Amt.
*First Name   CC Type
*Address   Card Number:
*City   Exp. Date
*State   CVV Code   3 digits on back of card
*Zip      
*Email      
  *Phone