Camper Registration

Registration 2019
18 MONTHS - FULL
2 YRS - FULL
3 YRS FULL
4 YRS - FULL
5 YRS - ALMOST FULL
6-13 YRS - SPACE AVAILABLE
Child 1*
First NameMiddle NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Allergies or medical concerns
Full Summer (June 25 August 9)Session 1 (June - 25-July 19)Session 2 (July 22nd-August 9)Week 1 (June 25- June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15- July 19)Week 5 (July 22- July 26)Week 6 (July 29- August 2)Week 7 (August 5 - August 9)
Child 2
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Allergies or medical concerns
Full Summer (June 25 August 9)Session 1 (June - 25-July 19)Session 2 (July 22nd-August 9)Week 1 (June 25- June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15- July 19)Week 5 (July 22- July 26)Week 6 (July 29- August 2)Week 7 (August 5 - August 9)
Child 3
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Allergies or medical concerns
Full Summer (June 25 August 9)Session 1 (June - 25-July 19)Session 2 (July 22nd-August 9)Week 1 (June 25- June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15- July 19)Week 5 (July 22- July 26)Week 6 (July 29- August 2)Week 7 (August 5 - August 9)
Child 4
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Allergies or medical concerns
Full Summer (June 25 August 9)Session 1 (June - 25-July 19)Session 2 (July 22nd-August 9)Week 1 (June 25- June 28)Week 2 (July 1 - July 5)Week 3 (July 8 - July 12)Week 4 (July 15- July 19)Week 5 (July 22- July 26)Week 6 (July 29- August 2)Week 7 (August 5 - August 9)
If you have additional children please contact us.
Pre & After Care
8:00am5:30pmBoth
Bus Transportation from Kosher Central Hollywood
NoYes
2. Parent information
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
Work Phone*
Area CodePhone Number
E-mail*Primary email
Cell Phone*
Area CodePhone Number
Father's info*
First NameLast Name
Work Phone*
Area CodePhone Number
E-mail*
Cell Phone*
Area CodePhone Number
How did you hear of us?
3. Emergency Information
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Pediatrician & Insurance*
First NameLast Name
Phone Number
Area CodePhone Number
Insurance*
Policy #*
4. Payment Information
A $100 non-refundable registration fee applies for each child to ensure a spot in our summer program.
Total
$0.00

Payment

Credit Card

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

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

CARPOOL & CAMPER RELEASE*
Morning carpool runs from 8:55am until 9:15 am and afternoon carpool runs from 3:15pm until 3:30pm for the preschool camp and 3:30 – 3:45 for the older camp. If you arrive at any other time, you must escort your child to /from the office or classroom. To release your child to anyone aside from his/her parents, or authorized for pickup, prior arrangements must be made with the Camp office. Proper identification must be shown each time your child is picked up.
TRIPS AND EXCURSIONS*
I hereby give Camp Gan Israel permission to take my child on all outings and trips and to sign any & all permission slips on behalf of my child.
PERSONAL PROPERTY*
Camp Gan Israel is not responsible for any stolen or lost items brought to camp. Please do not send your child with expensive electronics or toys
UNRULY BEHAVIOR*
Any camper who physically or emotionally harms him/herself or others is subject to suspension at the Camps discretion.
PROPERTY DAMAGE*
Any camp property damaged by a child, will be the responsibility of the parents to fix/ replace or reimburse.
SICK/MISSED DAYS*
No refunds will be given for any withdrawals and/or incomplete attendance regardless of the reason.
PAYMENTS*
If payment is not made by the early bird deadline, you will be charged the full rates. A $35 fee will be charged for all returned checks.
MEDIA*
Camp is hereby granted permission to use any photo or video showing our child/ren involved in camp activities.
EMERGENCIES (G-D FORBID)*
If an emergency arises (G-d forbid) and none of the above numbers can be contacted, I hereby give Camp Gan Israel permission to take whatever measure it feels proper and necessary considering circumstances.
General comments
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Registration 2019

2. Parent information

3. Emergency Information

4. Payment Information