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Registration Form
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Parent Name
*
Email
*
Amount of children attending camp
1
2
3
4
5
6
7
8
Child 1 Name
*
Child 1 Date Of Birth
*
Child 1 Grade the camper is entering
*
Child 2 Name
*
Child 2 Date Of Birth
*
Child 2 Grade the camper is entering
*
Child 3 Name
*
Child 3 Date Of Birth
*
Child 3 Grade the camper is entering
*
Child 4 Name
*
Child 4 Date Of Birth
*
Child 4 Grade the camper is entering
*
Child 5 Name
*
Child 5 Date Of Birth
*
Child 5 Grade the camper is entering
*
Child 6 Name
*
Child 6 Date Of Birth
*
Child 6 Grade the camper is entering
*
Child 7 Name
*
Child 7 Date Of Birth
*
Child 7 Grade the camper is entering
*
Child 8 Name
*
Child 8 Date Of Birth
*
Child 8 Grade the camper is entering
*
Weeks child/children attending will be attending camp:
*
Whole Summer June 26-July 28 - $1,350.00 / Per Child
Week 1: June 26 - June 30 - $300 / Per Child
Week 2: July 3 - July 7 - $300 / Per Child
Week 3: July 10 - July 14 - $300 / Per Child
Week 4: July 17 - July 21 - $300 / Per Child
Week 5: July 24 - July 29 - $300 / Per Child
Note:
If some children will be in camp for a different amount of time (Child A for Full Summer and Child B for Weeks 2 and 3) please add that note here.
Enrolled in FACTS
My family is already enrolled in FACTS (through DTA school/tuition management)
My family is not enrolled in FACTS.
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Name of Father
*
Father Cell Phone #
Father's Email
*
Judaism Status
Born Jewish
Converted
Not Jewish
Name of Mother
*
Mother Cell Phone #
Mother's Email
*
Judaism Status
Born Jewish
Converted
Not Jewish
Emergency Contact
*
List Any Allergies
List any Medications
Any other medical information we should know
School Children Attend
*
Jewish Day School
Hebrew School
Other
School Name
*
Children Adopted
*
Yes
No
Permissions, Waiver and Payment 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 also hereby give permission for my child to be taken on all field trips or outings sponsored by Chabad of Southern Nevada and Camp Gan Israel in the mode of transportation that the camp arranges.
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 Southern Nevada and Camp Gan Israel and its staff harmless and I hereby release said parties from all liability except in cases of gross negligence.
Please contact me regarding scholarships. Please note: There are a limited amount of scholarships available.
I understand that my registration is not complete until I submit this $100 non-refundable payment which will be credited towards the camp tuition.
Total
$0.00
Stripe Credit Card
*
Submit
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