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2017 Registration Form

2017 Registration Form

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Color_CGI_Logo_240.jpg 2017 Camp Gan Israel

Registration Form

Part 1: Camper Information

Camper's Name

Jewish Name

Birthday

Age / Grade Entering

Gender

Contact Number

Home Address

Part 2: Parent's Information

Father's Name

   

Father's Cell

Father's E-mail

Mother's Name

   

Mother's Cell

Mother's E-mail

Part 3: Date Selections

Week 1:
June 26 - 30

Three Day Selection:

Week 2: 4 Day
July 3 - 7

No Camp Tuesday July 4th

Three Day Selection:

Week 3:
July 10 - 14

Three Day Selection:

Week 4:
July 17 - 21

Three Day Selection:

Week 5:
July 24 - 28

Three Day Selection:

Week 6:
July 31 - Aug 4

Three Day Selection:

Week 7:
Aug 7 - 11

Three Day Selection:

After Care Selections:

Week 1: 6/26 - 30

Week 5: 7/24 - 28

Week 2: 7/3- 7

Week 6: 7/31-8/4

Week 3: 7/10 - 14

Week 7: 8/7 - 11

Week 4: 7/17 - 21

   

Part 4: Lunch Program (all served with a drink, fruit and veggies): $5 / Per Selection

These Kosher Meals are Prepared in our Kitchen

 

Monday

Tuesday

Wednesday

Thursday

Friday

Challah

 

Macaroni & Cheese

Chicken Nuggets

Deli or Tuna

Hot Dog

Pizza

For Shabbat

Week 1

Week 2

 

Week 3

Week 4

Week 5

Fish Sticks
Cream Cheese or Tuna Cream Cheese or Tuna

Week 6

Fish Sticks

Week 7

Part 5: Medical & Emergency Information

In case of emergency and a parent or guardian can not be reached - please contact:

Name #1

Name #2

Relationship #1

Relationship #2

Phone #1

Phone #2

Your son/daughter is below legal age of consent. The law requires that we have your permission if medical service should be needed. Your signature at the end of this form will authorize us to proceed with the care for lesser types of medical problems, which may occur.

Please indicate which action should be taken in the event of an emergency.

1. In the event of an emergency when a parent/guardian is unavailable, I hereby authorize a representative of Camp Gan Israel to make such arrangements as considered necessary for my child to receive medical or hospital care, including transportation. Under such circumstances, I further authorize the physician named below to undertake such care and treatment as considered necessary. In the event such physician is not available, I authorize such care and treatment to be performed by any licensed physician or surgeon.

2. I do not choose the above, I desire the following action to be taken in the event of an emergency

 

Medical Questionaire:

1. Can your child swim?

2. Does your child have any medical issues that we should know about (for example: asthma, allergies to food, allergies to medicines, hearing trouble, diabetes, physical disabilities etc)? Please specify.

3. Should there be any limits on your child’s physical activity?
If so, please specify.

4. Is your child taking medications at this time? If so, please specify.

5. Please list any other important information.

The undersigned agrees to bear all costs as a result of the foregoing.

Part 6: Concent:

By selecting "yes", I permit my child to participate in all activities of Camp Gan Israel, on site, off site and trips.

I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision.

I permit my child’s photo to be used on our Camp Website or e-mail newsletters.

This Child may Be Picked Up From Camp By:

Parent Signature:

Date:

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