Register

To avoid possible errors via mobile device, we suggest completing and submitting this registration from a computer.

How many campers?*

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

Week Selection & Before/After Care*

Day Selection* Select one option only

5 Full Days (9am - 3pm)3 Full Days5 Half Days (9am - 12pm)3 Half Days

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

Week Selection & Before/After Care*

Day Selection* Select one option only

5 Full Days (9am - 3pm)3 Full Days5 Half Days (9am - 12pm)3 Half Days

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

Week Selection & Before/After Care*

Day Selection* Select one option only

5 Full Days (9am - 3pm)3 Full Days5 Half Days (9am - 12pm)3 Half Days

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

Home address same as billing address?

Yes

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*

Comments Allergies or anything else we should be aware of?

Is your family Jewish?

Just MomJust DadBothNone

How did you hear about CGI? We would love to know how we can reach more new families!

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 Camp@VChabad.com.

Permissions* All of these must be selected. If you have a question or hesitation, kindly contact us.

I hereby give permission for my child to participate in all Camp Gan Israel activities.I hereby consent to the administration of Camp Gan Israel to take whatever medical meaures they deem necessary for my child, in the event of a medical emergency.I authorize Camp Gan Israel to have and use photographs, slides and videos of the person named on this application as needed for educational and public relations programs.

In order to submit your registration, a $200 deposit per child is required, payable by credit card only to be charged with this registration. For the remaining balance, you can also pay by check or with Zelle (to zelle@myvillagechabad.com).

Please select your payment method below.

Payment Terms*

Charge my card the full amount of the camp tuition upfront and waive the 3% credit card fee. Note: Final camp tuition amount (after any applicable discounts) will be sent to you shortly for approval before processing card.Charge my card the $200 deposit per child now, and I will send in the camp balance by check or Zelle (installments are ok) before 5/10. I understand that my card will be charged on 5/11 (for balance +3% processing fee) if check or Zelle payments are not submitted.

Rate Tier Selection* Choose the tuition tier you are comfortable with. See "Dates & Rates" to review exact rates for each tier.

Tier One - Standard RateTier Two - Subsidized Rate

Click here to open "Dates & Rates" page in new window

Optional Donation to Scholarship Fund I'd like to help another child attend Jewish summer camp!

$180.00$360.00$540.00

Total Deposit

$0.00

Payment*

⚠ You have not yet connected a credit card processor.

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

City

State / Province

Postal / Zip Code

Country

Camper Information

Parent Information

Emergency Information

Parental Consent

Payment Information