Camp Gan Israel 2023

REGISTER FOR SUMMER CAMP AT VILLAGE CHABAD

4 Weeks of Sunshine, Friendship and Fun for Ages 2 - 8 years
Camp Dates: June 26 - July 21

Times: 9:30am - 3:30pm (until 2pm on Fridays)

Ask about before/after care. $12/hr.
Camper Information
Camper 1
Child 1 Full Name*

First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Age as of June 28*
School Attending*
Male / Female*

FemaleMale
Child 2
Full Name

First Name Last Name
Hebrew Name
Date of Birth

Month Day Year
Age as of June 28
School Attending
Male / Female

FemaleMale
Child 3
Full Name

First Name Last Name
Hebrew Name
Date of Birth

Month Day Year
Age as of June 28
School Attending
Male / Female

FemaleMale
Parent Information
Mother's Name*

First Name Last Name
Father's Name

First Name Last Name
Home Phone

Area Code Phone Number
Mother's Mobile*

Area Code Phone Number
Father's Mobile*

Area Code Phone Number

Address*

E-mail*
Emergency Contact Information

If either parent is not reachable
Emergency Contact Name*

First Name Last Name
Relationship to Child*
Home/Work Phone

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
Physician or Medical Facility Information
Physician or Medical Facility Name*
Phone & Address*

Phone Address
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

As space is limited, early registration is suggested.
Week Selection*

Week 1Week 2Week 3Option 4
Camp Fees: $350/week. $100 non-refundable deposit per child required to complete this application. Full balance is due before camp begins. 5% off sibling discount. 5% off early bird discount for registrations before April 30th. For scholarship requests, email [email protected].
Amount*

$100

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
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

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 $100.00 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 Name Last Name
Comments
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REGISTER FOR SUMMER CAMP AT VILLAGE CHABAD