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Registration Application
Camp Gan Israel 2011
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Part one: Camper Information
First Name: Last Name:
Home Address: City: Zip:
Home Phone: T-Shirt Size
XS S Med Large
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/or week your child will be attending camp:
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Session One:
Sports Camp
June 27 - July 15
(3 Weeks)
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Session Two:
Science & Nature Camp
July 18 - July 29
(2 Weeks)
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Session Three:
Art & Drama Camp
Aug 1 - Aug 12
(2 Weeks)
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Part four: Please select your choices for the Daily Lunch Program:
Notes:
1. Snacks and cold drinks are given to the children throughout the day.
2. Please advise us if your child has any food allergies and/or must adhere to a special diet.
3. All lunches will be served together with a drink, fruit and vegetables.
Part five: Medical Information (confidential)
| In case of emergency, please: |
| 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. |
I do not choose the option on the left, please take the following action:
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In case of emergency, and a parent can not be reached, please contact:
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Emergency Contact #1
Name:
Phone:
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Emergency Contact #2
Name:
Phone:
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Please tell us about your child:
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| 1. Does your child have any severe medical problems that we should know about (for example: asthma, allergies to food, allergies to drugs, hearing trouble, epilepsy, diabetes, physical disabilities etc)? Please specify: |
| 2. Can your child swim? |
| 3. Is your child taking medications at this time? If so, please specify. |
| 4. What is the name of your primary doctor? |
| 5. What is the phone number to your primary doctor? |
Part six: Camp Consent & Trip Release Form
Comments/Questions:
Thank you very much.
An invoice will be mailed to you closer to the start of camp.
