Registration

REGISTRATION IS NOW CLOSED

PLEASE ADD YOUR CHILD TO THE WAITLIST & YOU WILL BE NOTIFIED IF
THERE IS AN OPENING.

THIS WORKS ON A FIRST COME FIRST SERVE BASIS.

Click Here to add your child to the waitlis

PLEASE DO NOT REGISTER BELOW UNLESS YOU WERE APPROVED ON THE WAITLIST.
Child 1*

First Name Middle Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Grade Entering August 2023*
School Currently Attending *
*

Full Summer ( June 26 - August 10)Week 1 (June 26 - June 30)Week 2 (July 3 - July 7)Week 3 (July 10 - July 14)Week 4 (July 17 - July 21)Week 5 (July 24- July 28)Week 6 (July 31 - August 4)Week 7 (August 7 - August 10)
Allergies or medical concerns*
Child 2

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering August 2023
School Currently Attending
Full Summer ( June 26 - August 10)Week 1 (June 26 - June 30)Week 2 (July 3 - July 7)Week 3 (July 10 - July 14)Week 4 (July 17 - July 21)Week 5 (July 24- July 28)Week 6 (July 31 - August 4)Week 7 (August 7 - August 10)
Allergies or medical concerns
Child 3

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering August 2023
School Currently Attending
Full Summer ( June 26 - August 10)Week 1 (June 26 - June 30)Week 2 (July 3 - July 7)Week 3 (July 10 - July 14)Week 4 (July 17 - July 21)Week 5 (July 24- July 28)Week 6 (July 31 - August 4)Week 7 (August 7 - August 10)
Allergies or medical concerns
Child 4

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
School Currently Attending
Grade Entering August 2023
Allergies or medical concerns
Full Summer ( June 26 - August 10)Week 1 (June 26 - June 30)Week 2 (July 3 - July 7)Week 3 (July 10 - July 14)Week 4 (July 17 - July 21)Week 5 (July 24- July 28)Week 6 (July 31 - August 4)Week 7 (August 7 - August 10)
If you have additional children please add in the comments below
Pre & After Care

8:00 -9:00am3:30 - 5:30pmBoth
Bus Transportation from Hollywood (Ages 6+) $2 a day*

NoYes
Bus Transportation from Chai Tots (Ages 6+) $2 a day*

NoYes
2. Parent information
Mother's info*

Mothers First Name Mothers Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail* Primary email
Father's info*

Fathers First Name Fathers Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail*

Home Address*

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

3. Emergency Information
Emergency Contact*

Emergency First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician *

Doctor First Name Last Name
Phone Number

Area Code Phone Number
Insurance*
Policy #*
4. Payment Information
A $150 non-refundable registration & security fee applies for each child to ensure a spot in our summer program.

Your acceptance & Invoice will be emailed to you. The bill needs to be paid in full by May 1st, 2023 to honor the early bird discount & by May 15th to secure your spot in camp.
Number of Children Registering*
Total

$0.00

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

PAYMENTS*

If payment is not made by the early bird deadline, you will be charged the full rates. A $35 fee will be charged for all returned checks.
CARPOOL & CAMPER RELEASE*

Morning carpool runs from 8:55am until 9:15 am and afternoon carpool runs from 3:15pm until 3:30pm for the preschool camp and 3:30 – 3:45 for the older camp. If you arrive at any other time, you must escort your child to /from the office or classroom. To release your child to anyone aside from his/her parents, or authorized for pickup, prior arrangements must be made with the Camp office. Proper identification must be shown each time your child is picked up.
TRIPS AND EXCURSIONS*

I hereby give Camp Gan Israel permission to take my child on all outings and trips and to sign any & all permission slips on behalf of my child.
PERSONAL PROPERTY*

Camp Gan Israel is not responsible for any stolen or lost items brought to camp. Please do not send your child with expensive electronics or toys
UNRULY BEHAVIOR*

Any camper who physically or emotionally harms him/herself or others is subject to suspension at the Camps discretion.
PROPERTY DAMAGE *

Any camp property damaged by a child, will be the responsibility of the parents to fix, replace or reimburse.
SICK/MISSED DAYS*

No refunds will be given for any withdrawals and/or incomplete attendance regardless of the reason.
MEDIA*

Camp is hereby granted permission to use any photo or video showing your child/ren involved in camp activities.
EMERGENCIES (G-D FORBID)*

If an emergency arises (G-d forbid) and none of the above numbers can be contacted, I hereby give Camp Gan Israel permission to take whatever measure it feels proper and necessary considering circumstances.
Vaccinations *

I confirm that all children attending camp are up to date with their vaccinations
General comments
A $150 per child registration fee will be charged when you submit this form. This fee is non refundable and will not be deducted from your summer camp bill total.
Should be Empty:

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2. Parent information

3. Emergency Information

4. Payment Information