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 2022*

Gender*

MaleFemale

Sessions ($275 per week)*

Early/Late care needed)

Early Care ($8 per kid per day)Late Care ($8 per kid per day) not available Friday

Child 2

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade entering in September 2022

Gender

MaleFemale

Sessions ($275 per week)

Early/Late care needed)

Early Care ($8 per kid per day)Late Care ($8 per kid per day) not available Friday

Child 3

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Grade entering in September 2022

Gender

MaleFemale

Sessions ($275 per week)

Early/Late care needed)

Early Care ($8 per kid per day)Late Care ($8 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

*

Charge me a deposit of $75 per child (full payment on June 27)Charge me in full today

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