Camp Register Form

Our campers enjoy a wide range of exciting activities and field trips in a warm, safe and vivacious atmosphere that exposes the beauty of our Jewish heritage and provides every child with a wonderful and fulfilling camp experience. CGI has all the benefits of specialty camps – rolled up into one!

Child 1*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Grade entering in September 2020*

Gender*

MaleFemale

Sessions ($225 per week)*

Early/Late care needed)

Early Care ($6 per kid per day)Late Care ($6 per kid per day) not available Friday

Child 2

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade entering in September 2020

Gender

MaleFemale

Sessions ($225 per week)

Early/Late care needed)

Early Care ($6 per kid per day)Late Care ($6 per kid per day) not available Friday

Child 3

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade entering in September 2020

Gender

MaleFemale

Sessions ($225 per week)

Early/Late care needed)

Early Care ($6 per kid per day)Late Care ($6 per kid per day) not available Friday

If you have additional children please contact us.

Primary Phone Number*

Area CodePhone Number

Address*

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

Mother's info

First NameLast Name

Cell Phone

Area CodePhone Number

E-mailPrimary email

Father's info

First NameLast Name

Cell Phone

Area CodePhone Number

E-mail

How did you hear of us?

Emergency Contact*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Pediatrician & Insurance

First NameLast Name

Phone Number

Area CodePhone Number

Insurance

Policy #

Any Allergies or Medications?*

YesNo

If yes please specify

Please provide a Credit Card for your camp file. You will not be charged at this time.

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Agreement*

I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

General comments

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information