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
Emergency & Health Information /
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
Tuition Payment information
All deposits are non-refundable within 30 days of camp start date. Thank you for understanding.
Camp Tuition Full Week Child 1

$200
Camp Tuition Daily Rate $50/Day. Child 1

$50$100$150$200$250
Child 1: Daily Option. Indicate which days your child will be attending

MondayTuesdayWednesdayThursdayFriday
Camp Tuition Full Week. Child 2

$200
Child 2: Daily Option. Indicate which days your child will be attending

MondayTuesdayWednesdayThursdayFriday
Camp Tuition Daily Rate $50/Day. Child 2

$50$100$150$200$250
Total

$0.00
Payment Type

Credit CardOther

Payment

Credit Card Zelle, Cash or Check

Postal / Zip Code

Country

I'd like to request a scholarship.

YesNoOption 3
Notes/Memo
For more information and questions, scholarship assistance, or payment plans, please call our office at 623.252.1759 or email at office @ichabad.org.
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Camper Information

Parents Information

Emergency & Health Information /

Tuition Payment information