Registration 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!
1. Child/ren’s Information
Child 1*

First Name Middle Name Last Name
Birth Date*

Month Day Year
Grade entering in September 2023*
Gender*

MaleFemale
Sessions - $285 per week (prior to April 15)*

Week 1Week 2Week 3Week 4Full Summer - $10805% Multi Camper Discount (cannot combine with full summer discount)
Morning Care $40/week Discounts not applied

Week 1Week 2Week 3Week 4
After Care $40/week (Not available Friday Discounts not applied

Week 1Week 2Week 3Week 4
Child 2

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade entering in September 2023
Gender

MaleFemale
Sessions - $285 per week (prior to April 15)

Week 1Week 2Week 3Week 4Full Summer - $10805% Multi Camper Discount (cannot combine with full summer discount)
Morning Care $40/week Discounts not applied

Week 1Week 2Week 3Week 4
Child 3

First Name Middle Name Last Name
Birth Date

Month Day Year
Grade entering in September 2023
Gender

MaleFemale
Sessions - $285 per week (prior to April 15)

Week 1Week 2Week 3Week 4Full Summer - $10805% Multi Camper Discount (cannot combine with full summer discount)
Morning Care $40/week Discounts not applied

Week 1Week 2Week 3Week 4
After Care $40/week (Not available Friday Discounts not applied

Week 1Week 2Week 3Week 4
If you have additional children please contact us.
2. Parent information
Primary Phone Number*

Area Code Phone Number

Address*

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

Mother's info

First Name Last Name
Cell Phone

Area Code Phone Number
E-mail Primary email
Father's info

First Name Last Name
Cell Phone

Area Code Phone Number
E-mail
How did you hear of us?
3. Emergency Information
Emergency Contact*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician & Insurance

First Name Last Name
Phone Number

Area Code Phone Number
Insurance
Policy #
Any Allergies or Medications?*

YesNo
If yes please specify
4. Payment Information
Total

$0.00
*

Charge me a deposit of $150 per child (full payment on June 26)Charge me in full today

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
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
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1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information