Camp Gan Izzy Registration

Camper Information
Child 1
First Name Last Name
Birth Date

Month Day Year
Entering Grade
T-Shirt Size

SmallMediumLarge
Child 2
First Name Last Name
Birth Date

Month Day Year
Entering Grade
T-Shirt Size

SmallMediumLarge
Parents Information
Mother's Name
E-mail*
Cell Phone Number
Father's Name
First Name Last Name
E-mail*
Cell Phone Number
Please list any known allergies that your child has:
Please describe any medical conditions or behavioral issues that would be beneficial to know in caring for your child.
I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation, and to obtain emergency medical care as the situation mandates. I agree that Camp Gan Israel, its administration and staff, will not be liable for any injury or health impairment that may occur. My child has permission to participate in any field trip or activity done with Camp Gan Israel. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

Yes
Camp Tuition Child 1

$200
Camp Tuition Child 2

$200
Total

$0.00
Payment Type

Credit CardZelle [email protected]Other

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Camper Information