2019 Camp Register Form - Camp Gan Israel

Our campers enjoy a wide range of exciting activities and field trips in a warm, safe and vivacious atmosphere that exposes the beauty of our Jewish heritage and provides every child with a wonderful and fulfilling camp experience. CGI has all the benefits of specialty camps – rolled up into one!
1. Camper's Information
Please fill out a separate form for each additional child
Camper's Name*
First NameMiddle NameLast Name
Birth Date*
MonthDayYear
Grade Entering in September 2019
Gender*
MaleFemale
Camp T-shirt Size
2. Date Selection
Week One: June 24 - June 28
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week One 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Hot Dog LunchFriday Pizza LunchFriday Challah
Week Two: July 1 - July 5
Full 4-Day Camp Experience3-Day Camp Experience
No camp Thursday, July 4th
Please enter your Week Two 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchFriday Pizza LunchFriday Challah
Week Three: July 8 - July 12
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week Three 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Hot Dog LunchFriday Pizza LunchFriday Challah
Week Four: July 15 - July 19
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week Four 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Hot Dog LunchFriday Pizza LunchFriday Challah
Week Five: July 22 - July 26
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week Five 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Hot Dog LunchFriday Pizza LunchFriday Challah
Week Six: July 29 - August 2
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week Six 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Hot Dog LunchFriday Pizza LunchFriday Challah
Week Seven: August 5 - August 9
Full 5-Day Camp Experience3-Day Camp Experience
Please enter your Week Seven 3-Day Selection
AM / PM CareJust AM CareJust PM Care
Monday Mac & Cheese LunchTuesday Fish Sticks LunchWednesday Sandwich LunchThursday Sandwich LunchFriday Pizza LunchFriday Challah
3. Parent Information
Primary Phone Number*
Area CodePhone Number

Address*

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

Mother's info
First NameLast Name
Cell Phone
Area CodePhone Number
E-mail*Primary email
Father's info
First NameLast Name
Cell Phone
Area CodePhone Number
E-mail
How did you hear of us?
4. Emergency Information
Emergency Contact*
First NameLast Name
Emergency Contact Phone Number*
Area CodePhone Number
Relationship*
Pediatrician & Insurance
First NameLast Name
Phone Number
Area CodePhone Number
Insurance
Policy #
5. Credit Card Information
Please provide a Credit Card for your camp file. You will not be charged at this time.

Payment Information

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

6. A Few Questions:
Does your child have any medical issues that we should know about?
NoAllergies to FoodAsthmaPhysical LimitationAllergies to Medicines
Is your child taking medications at this time?
YesNo
If so, please specify
What is your child's favorite activity?
6. Permissions
This Child may Be Picked Up From Camp By:
Grandparents, Nannies, Friends...
WhatsApp Notifications
Yes, I would like to receive notifications as to the latest updates during camp to the primary phone number listed aboveNo, thank you
Trip Agreement*
I permit my child to participate in all activities of Camp Gan Israel, on site, off site and trips.
Medical Agreement 1*
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.
Medical Agreement 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.
In Case of Emergency*
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 above 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 above, I desire the following action to be taken in the event of an emergency:
Please advise
The undersigned agrees to bear all costs as a result of the foregoing.*
Yes
Permission to apply sunscreen*
Yes, please re-apply sunscreen as neededNo, please do not apply sunscreen at any time throughout the day
Photo Agreement*
I permit my child’s photo to be used on our Camp Website or e-mail newsletters.I do not permit my child’s photo to be used on our Camp Website or e-mail newsletters.
General comments
Parent Signature*
Should be Empty:

1. Camper's Information

2. Date Selection

3. Parent Information

4. Emergency Information

5. Credit Card Information

6. A Few Questions:

6. Permissions