This express form is only for campers that registered for CGI Summer 2019. 

For Dates & Rates please  click here

 

Camper 1

Camper 2

Camper 3

Camper's First Name

Camper's First Name

Camper's First Name

Camper's Last Name

Camper's Last Name

Camper's Last Name

Additional Camper Information

Camper 1

Camper 2

Camper 3

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

Same school and following grade as last year?
Yes No

Same school and following grade as last year?
Yes No

Same school and following grade as last year?
Yes No

Same medical, behavioral and allergic concerns as last year?
Yes No

Same medical, behavioral and allergic concerns as last year?
Yes No

Same medical, behavioral and allergic concerns as last year?
Yes No

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 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 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  

If you answered "no" to any of these questions, please enumerate:

If you answered "no" to any of these questions, please enumerate:
 

If you answered "no" to any of these questions, please enumerate:
 

Parents' Information

Same address as last year?
Yes No

Same phone numbers as last year?
Yes No

Same emails as last year?
Yes No

If you answered "no" to any of these questions, please enumerate:

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 for one week $550 for complete session 
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 August 5th 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 fee.

Parent/Guardian Date

Parent's Email 

Payment Details

 How would you like to pay the tuition cost?
ALL AT ONCE: $550 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 on August 5th. If you need to set up a different payment plan, it must be coordinated with Director.

Last Name on Card

First Name on Card

Current Charge Amount 
$ 

Card Number 

Exp. Date
    

CVV code - 3 digits on back or card or 4 on front of card for AMEX

Description of Payment
Comments

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