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Youth and Teens Camp Gan Israel

Camp Registration Form - Summer 2026

1. Child/ren’s Information
Child 1*
First Name Middle Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
*Early Bird discounts and sibling discounts are automatically applied
Sessions ($300 per session)*

Week 1Week 2Week 3Week 4
Child 2
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Sessions (Sibling discount - $270 per session)

Week 1Week 2Week 3Week 4
Child 3
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Sessions (Sibling discount - $270 per session)

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

Area Code Phone Number
E-mail Primary email
Cell Phone

Area Code Phone Number
Father's info
First Name Last Name
Work Phone

Area Code Phone Number
E-mail
Cell Phone

Area Code Phone Number
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 #
4. Payment Information
Non-refundable registration fee

$50
A $50 non-refundable registration fee applies as part of this registration.
Total

$0.00

I would like to pay today:Full amount20% minimum: $0.00 $
Yes, I'd like to donate the cost of processing this transaction by adding 2.9%

Payment

Credit Card Cash or Check

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
Should be Empty:

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