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. 

Camper/Parent Information
Name
  First
Middle Last  
Address
  Street
City State
Zip
Date of Birth
   
Contact Info
  Phone
Email
 
Schools
  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  
Email
     
         
           
Select Child's Age Group
Ages 10-12
Ages 3-4  
Ages 5-9
 
   
 
 
Please indicate which sessions your child will attend camp (you can select multiple weeks):
 
   
     
IMPORTANT
All forms must be completed and submitted before your child begins camp
 
I will be paying by:  Mastercard Visa Amex Discover
   $136/WEEK/CHILD OR $900/SEASON/CHILD FOR CAMP GAN ISRAEL

 

PAYMENT INFORMATION:  
*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