Camp Gan Israel 2020

REGISTER FOR SUMMER CAMP AT VILLAGE CHABAD
Six Weeks of Covid-Safe Sunshine, Friendship and Fun for Ages 3 - 6
Camper Information
Child's Full Name*
First NameLast Name
Hebrew Name*
Date of Birth*
MonthDayYear
Age as of June 29*
School Attending*
Grade*
Male / Female*
FemaleMale
Parent Information
Mother's Name*
First NameLast Name
Father's Name
First NameLast Name
Home Phone
Area CodePhone Number
Mother's Mobile*
Area CodePhone Number
Father's Mobile*
Area CodePhone Number

Address*

E-mail*
Emergency Contact Information
If either parent is not reachable
Emergency Contact Name*
First NameLast Name
Relationship to Child*
Home/Work Phone
Area CodePhone Number
Mobile Phone*
Area CodePhone Number
Physician or Medical Facility Information
Physician or Medical Facility Name*
Phone & Address*
PhoneAddress
Policy Number*
To complete registration, please email a copy of your child's insurance card and health form to [email protected] .
Camp Tuition and Program Selection
Due to added social distancing guidelines, space is limited. Register ASAP to reserve.
Week Selection*
Week 1Week 2Week 3Week 4Week 5Week 6
Camp Fees: $350/week. $50 non-refundable deposit required to complete this application. Complete payment balance is due before camp begins. For discount or scholarship requests, email [email protected]
Amount*
$50

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Parental Consent
Yes! You can include my child’s photo to be used on the website, video & any other Camp Gan Israel related publications. I hereby permit my child to participate in all activities at Village Chabad camp. I release Village Chabad Camp Gan Israel and individuals from liability in case of accident during activities related to camp, including any Covid-19 related issues, as long as normal safety procedures have been taken. I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision. I am enclosing the minimum deposit of $50.00 for each child towards camp tuition. I understand that the fee is non-refundable. 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 fees before camp begins.
Full Name*
First NameLast Name
Comments
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REGISTER FOR SUMMER CAMP AT VILLAGE CHABAD