Register Online Please fill out the form below: Camper 1 Camper 2 Camper 3 Campers Full Name Campers Full Name Campers Full Name Date of Birth Date of Birth Date of Birth Gender Gender Gender School Attending School Attending School Attending Entering Grade Entering Grade Entering Grade General Information Previous Camps Attended How did you hear about Camp Gan Israel? What goals would you like to see your child/ren accomplish during camp? Briefly describe your child/ren's personality Child/ren's favorite activities Fees 1st Session: July 8 - 12 2nd Session: July 15 - 19 Each Session - $200 | lunches provided at $20 per week Monday-Friday 9:30am-2:30pm Camp T-shirts Camp T-Shirt 1 T-Shirt is included per child. Campers are required to wear a Camp T-Shirt on trip days. Child 0 1 2 3 4 5 6 7 8 9 10 Small 0 1 2 3 4 5 6 7 8 9 10 Medium 0 1 2 3 4 5 6 7 8 9 10 Large Adult 0 1 2 3 4 5 6 7 8 9 10 Small 0 1 2 3 4 5 6 7 8 9 10 Medium 0 1 2 3 4 5 6 7 8 9 10 Large Parents' Information Parents' Status Married Widowed Divorced Separated Home Phone Home Address City State Zip Father's Full Name Work Phone Cell Phone Email Mother's Full Name Work Phone Cell Phone Email Comments Emergency Contact Information Contact 1 Phone Relationship to child Contact 2 Phone Relationship to child Family Physician Phone Are there any medical concerns that your child's counselor should be aware of? Permission I hereby give permission for my child to participate in all Camp Gan Israel of Coronado activities and trips I also hereby consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary for my child, in the event of a medical emergency Parent/Guardian Date Payment Details Last Name Total charge amount First Name Card Type Please Select Visa American Express Discover Mastercard Address Card Number City Exp. Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 State CVV code 3 digits on back of card Zip Comments This page uses 128 bit SSL encryption to keep your data secure.
