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Summer Camp
Please verify reCaptcha before submitting the form.
Registration Is Open For Summer 2023!
Child's Information
First Name
Last Name
Date of Birth
Month
Date
Year
Gender
Male
Male
Female
Female
T-Shirt
XS
S
M
L
XL
XXL
School Information
Name of School
Grade entering in September 2023
First Name
Last Name
Date of Birth
Month
Date
Year
Gender
Male
Male
Female
Female
T-Shirt
XS
S
M
L
XL
XXL
School Information
Name of School
Grade entering in September 2023
Parent/Guardian
First Name
Last Name
Cell Phone
Email Address
Home/Mailing Address
Street Address Line 1
Street Address Line 2
City
State/Province
Postal/Zip Code
Country
Additional Contact (In Case of Emergency)
Emergency Contact Name
First Name
Last Name
Phone Number
Relationship
Medical Information
Insurance Provider
Policy Number
Name of Doctor
Doctor's Phone
Allergies (If yes, please explain)
Does your child take medication regularly? (If yes, please specify)
Does your child have any medical (physical, emotional, or mental) conditions we should be aware of?
Additional medical information
Permissions And Waiver
(Check each box after reading the waiver)
In the event that neither parent nor the emergency person can be contacted, Camp Gan Israel has my permission to render any necessary first aid or to secure care by a physician to my child while attending camp.
*
I agree
I agree
I hereby give permission for my child to be taken off-campus on all outings by Camp Gan Israel for Field trips, hiking or the beach. This completed form may be photocopied for outings. I give permission to Camp Gan Israel to use camp photos of my children in any camp publicity.
*
I agree
I agree
I understand that Gan Israel Day Camp is carrying limited liability insurance protecting the camp premises against physical damage and covering the camp staff against negligence. Nevertheless, I agree to accept complete responsibility for damages caused by my child and for injuries incurred and agree to hold Chabad of Pacific Palisades and Camp Gan Israel and its staff harmless and I hereby release said parties from all liability except in cases of gross negligence.
*
I agree
I agree
Camp Rate:
Registration Fee per Camper:
Full Summer: $485 (includes 1 camp tshirt)
Early bird special (by april 18)
$470
Registration Fee per Camper:
Full Summer: $485 (includes 1 camp tshirt)
Early bird special (by april 18)
$470
No. of Campers
Optional:
Additional T-Shirts: $15 per T-Shirt, Lunch: $20/week
No. of additional T-Shirt/s
No. of lunches
Sponsorships
I'd like to give another camper the opportunity to join Camp Gan Yisroel
I'd like to give another camper the opportunity to join Camp Gan Yisroel
Other Amount
How will you pay?
Cash
Check
Credit Card (3% CC Fee Applies)
Notes:
I would like to receive news and updates by email
I would like to receive news and updates by email
For more information call or text us at 310-666-2302
Tue, November 5 2024 4 Cheshvan 5785