Campers that attended Summer Camp 2019 may use the Express Registration Form, Click Here

For Dates, Rates & COVID-19 Safety Precautions, please click here

 

Camper 1 Camper 2 Camper 3
Camper's First Name
Camper's First Name
Camper's Fist Name
Camper's Last Name
Camper's Last Name
Camper's Last Name
Hebrew Name
Hebrew Name
Hebrew Name
Age
Age
Age
Date of Birth
Date of Birth
Date of Birth
Born after Sunset
Yes No
Born after Sunset
Yes No
Born after Sunset
Yes No
Gender
Gender
Gender
School Attending
School Attending
School Attending
Entering Grade (Fall 2020)
Entering Grade (Fall 2020)
Entering Grade (Fall 2020)
      
Additional Camper Information
Camper 1 Camper 2 Camper 3
In which extracurricular activities does your child participate throughout the year?
In which extracurricular activities does your child participate throughout the year?
In which extracurricular activities does your child participate throughout the year?
Can your child swim in deep water?
Yes No
Can your child swim in deep water?
Yes No
Can your child swim in deep water?
Yes No
Describe your child's swimming capabilities:
Describe your child's swimming capabilities:
Describe your child's swimming capabilities:
Previous Camps Attended

Previous Camps Attended

Previous Camps Attended

 

Parents' Information
Parents' Status Married Widowed Divorced Separated
Home phone
Home Address
   
 
City
State
Zip
Father
First name
Last name
Hebrew name
 
cell phone
work phone
email
Occupation
   
Mother
First name
Last name
Hebrew name

cell phone
work phone
email
Occupation
   

Is the natural mother of the child/ren Jewish?
Yes No

Were there any conversions or adoptions in the family? 
Yes No 
If yes, please explain: 
 
Please let us know if you are interested in early care of after care. If there is enough interest we will try to accommodate: 
Synagogue Affiliation:
How did you hear about Camp Gan Israel at The Shul?
 Email/Website Facebook *Friend
  
Comments
       

Medical Form

Camper 1 Camper 2 Camper 3

Is your child's children's immunizations up to date?
(CGI requires all campers to be up to date with immunizations unless they have a medical exemption)

 Yes   No   
 Other  

Is your child's immunizations up to date?
(CGI requires all campers to be up to date with immunizations unless they have a medical exemption)      

 Yes   No   
 Other  

Is your child's immunizations up to date?
(CGI requires all campers to be up to date with immunizations unless they have a medical exemption)      

 Yes   No   
 Other  

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen 

Motrin - Ibuprofen

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen

Motrin - Ibuprofen 

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen

Motrin - Ibuprofen 


PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication



PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication



PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication


Does your child have any known allergies?

Does your child have any known allergies? 

Does your child have any known allergies? 

Is your child on any medication?
Is your child on any medication? Is your child on any medication?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Emergency Contact Information
Emergency Contact (besides parent)
Phone
Relationship to child
Family Physician
Phone

Release Authorization

In the event that I am not able to pick up my child, he/she may be released only to the following people:

1.   2. 

3.     4

Enrollment & Fees

Week 1: August 16-20

Week 1: August 16-20

Week 1: August 16-20

Week 2: August 23-27 Week 2: August 23-27 Week 2: August 23-27

I would like to enroll in:

 Main Camp
Hebrew Immersion Camp 

For Dates & Rates please   click here

SPONSOR A CAMPER - CAMP GAN ISRAEL SCHOLARSHIP FUND
Yes! I would like to enable another child to enjoy a summer at Camp Gan Israel.
I am enclosing: $275.00 for one week $1000 for full summer
Other - $ towards tuition for another camper.
Permission

I hereby permit my child to participate in all activities at Camp Gan Israel at The Shul – on site, off-site and trips. I permit Camp Gan Israel to transport my child(ren) on camp-provided transportation and to obtain emergency medical care as the situation mandates. I release Camp Gan Israel at The Shul and individuals from liability in case of accident during activities related to Camp Gan Israel at The Shul, as long as normal safety procedures have been taken. I allow Camp Gan Israel to photograph and/or videotape my child(ren) to be used on the website, video & any other Camp Gan Israel related publications. I understand that my child may be dismissed during a camp day, due to illness or unacceptable behavior, at the discretion of the camp, and I agree to abide by the director’s decision. I understand that my $100 deposit is non-refundable and that the deposit is processed immediately. I understand that after July 16th the tuition is non-refundable and that refunds will not be made for incomplete attendance. In addition, I understand that submitting a registration form and payment does not guarantee me a spot in camp, and that acceptance into Camp Gan Israel is at the discretion of the camp.

The parent who signs the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp tuition.

Parent/Guardian Date
Payment Details
I will pay: 
Full Tuition 
Subsidized Tuition 
How would you like to pay the tuition cost?
ALL AT ONCE: $100 will be charged now and we will automatically charge the rest when we process the registration
PAYMENT PLAN: $100 non-refundable deposit is due now. Remaining tuition will be charged in 2 installments on June 1st and July 1st. If you need to set up a different payment plan, it must be coordinated with the Camp Director.
First Name
Last Name
Current Charge Amount 
Card Number 
Exp. Date
    
CVV code - 3 digits on back or card or 4 on front of card for AMEX 
Comments 
Promo code

Description of Payment
     
Camp Gan Israel at The Shul
For more information please call 248-788-4000 or email [email protected]