Register Online! - Camp Gan Israel of Martin & S. Lucie County

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.
Mother's Contact Info
Child's Mother*
First Name Last Name Hebrew Name
Mother's Email:*
Work Phone:*
Cell Phone:*
Father's Contact Info
Child's Father*
First Name Last Name Hebrew Name
Work Phone:*
Cell Phone:*
Father's E-mail:*
Marital Status:*
Child resides with:*
Child's Info
Please note there is also a registration fee of $60 per child
Registration fee*

$60
Child Full Name:*
First Name Middle Name Last Name Hebrew Name

Address:*

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

Date of Birth:*

Month Day Year
Attending:*

Full Season - $1,240Session 1 (June 22 - July 3) - $620Session 2 (July 6 - July 17) - $620
Gender:*

BoyGirl
Age:*
School:*
Grade completed this June:*
Click here to add a second child.
Child 2 Info
Please note there is also a registration fee of $60 per child
Registration fee*

$60
Child Full Name:*
First Name Middle Name Last Name Hebrew Name

Address*

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

Date of Birth:*

Month Day Year
Attending:* With sibling discount.

Full Season - $1,178Session 1 (June 22 - July 3) - $589Session 2 (July 6 - July 17) - $589
Gender:*

BoyGirl
Age:*
School*
Grade completed this June:*
Persons authorized to pick up camper
1. Name and Phone of person authorized to pick up camper*
First Name Last Name Phone #
2. Name and Phone of person authorized to pick up camper*
First Name Last Name Phone #
3. Name and Phone of person authorized to pick up camper
First Name Last Name Phone #
4. Name and Phone of person authorized to pick up camper
First Name Last Name Phone #
Emergency Contact Info
Emergency Contact 1:*
First Name Last Name Phone Relationship
Emergency Contact 2:*
First Name Last Name Phone Relationship
Medical/Health Information
Family Physician:*
First Name Last Name
Insurance Policy:*
Policy#:*
Medication that your child takes regularly:*
Will this medication need to be dispensed at camp?*

YesNo
If yes please explain:*
Special dietary needs or restrictions:*
Any recent surgery or serious illness:
List any allergies (food or medication)
Is your child prone to:

Ear infectionSinus infection
Please Explain:*
Does your child have any mental or social handicap or any other problem of which we should be aware in caring for him/her?
General Information:
Camper’s strong likes and dislikes:*
Camper makes friends:*

EasilyFairly wellWith difficulty
How does your child feel about going to camp this summer?*
Are there any special situations or difficult transitions in your Child’s life (i.e.-moving, school, changes in family situations, etc.)? It is important for your child that you use this space to share this information with us*
What is the most important thing that you would like us to know about your child?*
Family Info
Is the natural mother of child Jewish?*

YesNoConvertedChild adopted, we don't know
Is the natural father of child Jewish?*

YesNoConvertedChild adopted, we don't know
Are you affiliated with any Synagogue?*

YesNo
Synagogue Name:*
Does your child attend Hebrew school?*

YesNo
Name of Hebrew School:*
Does your child swim? *

YesNo
Does your child have fear of water? *

YesNo
Please Explain:*
I would like to buy T-Shirts
$15/T-Shirt
T-shirt size:*

6-810-1214-16Adult SAdult MAdult L
Total:

$0.00

I would like to pay today:Full amount25% minimum: $0.00 $

Payment:*

Credit Card Zelle

Postal / Zip Code

Country

Comments:*
Where did you hear about Camp Gan Israel?*
IMPORTANT
*

I will mail or bring in a copy of my child’s immunization records and child’s health examinations forms (blue and Yellow). Registration is not complete without this.
*

I give my permission to use the photograph of my child as well as myself for promotional purposes. Camp group list can be disseminated with campers and parents names and phone numbers.
*

I understand that in case of emergency and I am unable to be contacted, I give permission to Camp Gan Israel to authorize any emergency action necessary to insure the safety of my child.
*

I understand that by participating in any Camp Gan Israel activities and use of any recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities to be conducted by the Camp Gan Israel, I/ We as an individual or as a parent or guardian of the participants named herein, assume all risk and hazards incidental to the activities and release from responsibility and agree to indemnify and hold harmless the Camp Gan Israel, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at or conducted by Camp Gan Israel.
*

I understand that all deposits are non refundable.
*

I understand that by enrolling in Camp Gan Israel I am agreeing to abide by all its policies.
*

I have read the parent handbook and application form and agree to the terms stated.
Date of Application:*

Month Day Year
Initials:*
1. Please note: These numbers are needed in event of an emergency.
2. Actual shirt sizes run small (e.g., if you need a 10-12 size order 14-16, etc.)
3. Registration not complete until 25% deposit is received. (unless other arrangements have been made). Full payment is required by May 1st.
4. Please include total for tuition and T-shirt fee. Thank you. For rates click here .
Should be Empty:

Mother's Contact Info

Father's Contact Info

Child's Info

Child 2 Info

Persons authorized to pick up camper

Emergency Contact Info

Medical/Health Information

General Information:

Family Info

IMPORTANT