REGISTRATION FORM - CAMP GAN ISRAEL 2022

AGES: 2 - 6

LOCATION: 360 Nicolls Rd, East Setauket NY 11733

DATES: June 27 - July 15

TIMES: Mon - Thurs: 9:30am - 3:30pm, Fri: 9:30am - 2:00pm (Before/After Care $10/hr upon request)

RATES: $350 per week

Please complete the form below carefully. This form is good for up to 3 children. 

Space is reserved once deposit is received.   

1. Camper's Name: 
  Hebrew Name
  Nickname
  Gender & DOB M F 
  Grade
  New/Returning New Camper  Returning Camper
   

Any special concerns/allergies/requests regarding camper? 

 

2. Camper's Name: 

  Hebrew Name
  Nickname

 

 Gender & DOB  M  F 
  Grade
  New/Returning New Camper   Returning Camper
    Any special concerns/allergies/requests regarding camper?

 
3. Camper's Name: 
  Hebrew Name
  Nickname

 

 Gender & DOB   M   F 
  Grade
  New/Returning New Camper Returning Camper
    Any special concerns/allergies/requests regarding camper?

 

Family Information
  Mother's Name
  Mother's Cell
  Mother's Work
  Father's Name
  Father's Cell
  Father's Work

 

 Street Address
  City/State/Zip
  Home
  E-mail
  Referred by
 

Additional Comments or Requests 

 

 
Important Information
 

Balance is due by June 25, 2022.  In the event full payment is not received by June 26, your credit card will be charged for the balance of the fee.  There is a 3% charge added for credit card payments.

   I have read the camp's terms and conditions and agree to the terms and conditions stated.
 
Payment Information
  Name on Card  
  Card #
  Card Type/Exp. Date
  CVV Number
  Payment Terms Charge my card the full amount (3% cc charge will be added)
Charge my card a non-refundable $100 deposit today and the balance will be paid prior to camp commencing (3% cc charge will be added)