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Camp Gan Izzy - Registration Form 2017

Please complete the entire form

Campers Info:

Last Name:

First Name:

Hebrew Name:

Date Of Birth: Gender:

Home Address:

City: State: Zip Code:

Home Phone:

E-mail:

School Sept. 2015: Entering Grade:

Fathers Name: Cell Phone:

Mothers Name: Cell Phone:

Emergency Contact Name: Cell Phone:

Doctor Name: Doctor Phone:

Session and fee schedule:

Week one: June 26 - June 30 $185

Week two: July 3 - July 7 $185

Week three: July 8- July 14 $185

Week four: July 17- July 21 $185

Week five: July 24- July 28 $185 

Full Summer: $800

I would like to sponsor a child for a week of fun $185

I would like to sponsor a child for a summer of fun $800

Payment information

Credit Card Type:

Name on card:

Credit Card Number:

Ex. Date (Day/Month):

CVV-Code:

 

In case of emergency, I request Camp Gan Israel Day Camp to contact me. If the camp is unable to reach me, I hereby authorize the camp to call the physician indicated above and to follow his instructions. If camp cannot contact this physician, the camp may make whatever arrangements seem necessary. I hereby give permission for campers to attend all the field trips the camp will be taking. I understand that the camp will provide transportation, and that safety precautions will be taken at all times. Gan Israel will make every effort to insure the well-being of every camper. However, it will not be responsible for any injury or health impairment of any camper. Gan Israel will not be responsible for damage to or loss of clothing or personal belongings of any camper.

I allow Camp Gan Israel to use my child(ren)’s photograph for all promotional purposes.

I understand that my deposit is non-refundable,and that refunds will not be made for incomplete attendance. I fully understand and agree to these conditions, and have stated all of the above information correctly

The parent who signs this registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fees.

 

I Agree



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