Part one: Camper Information

First Name:                         Last Name: 
      

Home Address:

 City                                                   Zip
       

Home Phone:

Birthdate:                  Age:            Gender:                                             Jewish Name
                  

Part two: Parents Information

Father's Name:                      Father's Cell Phone:                    
         

Father's E-mail:                                                  
       

Mother's Name:                  Mother's Cell Phone:                
       

 Mother's E-Mail:

Part three: Please select which session and week your child is attending camp:

Session One: Sports Camp
June 30 - July 15   (2 1/2 Weeks) 

Session Two: Science & Nature Camp
July  19 - August 5   (3 Weeks)

Session Three: Art & Drama Camp 
June 30 - July 2    (2 Weeks)  

 What size is your child for the camp T-shirt?
 XS    S    Med   Large     

Part four: Medical Information (confidential)  
    - Please fill out the complete Medical Consent Form located here

Emergency Contact Name:          Phone:
        

Is there any special medical which we should be aware of?

Part five: Camp Concent & Trip Release Form
    - Please fill out the complete Consent & Trip Release Form located here

Part six: Referrals

How did you hear about Camp Gan Israel?

Comments/Questions: