Camp Registration

Number of children being registered*

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Gender*

Grade entering*

Sessions* ($300 per session, $1050 for all 4)

Is your child allergic to any foods? If yes, please explain*

Pediatrician

First Name Last Name

Phone Number

Medical Insurance. Name & Number

Does your child have a medical, developmental or emotional condition that camp should be aware of? If yes, please explain

Please answer as accurately as possible - My child is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Shirt size

Sign up for Pizza day. (Beths Pizza is offered on Tuesdays. $5 a week)

YesNo

How Many Sessions?

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Gender*

Grade entering*

Sessions * (Siblings discount: $285 per session, $1000 for all 4)

Is your child allergic to any foods? If yes, please explain*

Pediatrician

First Name Last Name

Phone Number

Medical Insurance. Name & Number

Does your child have a medical, developmental or emotional condition that camp should be aware of? If yes, please explain

Please answer as accurately as possible - My child is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Shirt size

Sign up for Pizza day. (Beths Pizza is offered on Tuesdays. $5 a week)

YesNo

How Many Sessions?

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Gender*

Grade entering*

Sessions* (Siblings discount: $285 per session, $1000 for all 4)

Is your child allergic to any foods? If yes, please explain*

Pediatrician

First Name Last Name

Phone Number

Medical Insurance. Name & Number

Does your child have a medical, developmental or emotional condition that camp should be aware of? If yes, please explain

Please answer as accurately as possible - My child is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

Shirt size

Sign up for Pizza day. (Beths Pizza is offered on Tuesdays. $5 a week)

YesNo

How Many Sessions?

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Gender*

Grade entering*

Sessions * (Siblings discount: $285 per session, $1000 for all 4)

Is your child allergic to any foods? If yes, please explain*

Please answer as accurately as possible - My child is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.

Are there any social or other challenges we should be aware of?

If you have additional children, please contact us.

Full Name*

Phone Number*

Area Code Phone Number

Address*

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

E-mail* Primary email

Marital Status*

MarriedSingleDivorcedSeparated

Religion*

Jewish by birthJewish by conversionNot Jewish

Full Name*

Phone Number*

Area Code Phone Number

Same address as mother

.

Address*

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

E-mail* Primary email

Marital Status*

MarriedSingleDivorcedSeparated

Religion*

Jewish by birthJewish by conversionNot Jewish

Child may be picked up from camp by:*

Name and Relationship

Where did you hear about us?

I would like to receive news and updates by email

Emergency Contact*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship*

I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Camp Gan Israel will undertake such a decision.

Additional comments

Signature of Parent or Guardian*

Total

$0.00

I would like to pay today:Full amount$50.00 minimum$

Our mission is that every child deserves an unforgettable summer filled with fun, friendship, and Jewish pride.

If camp tuition presents a challenge, financial assistance is available upon request.

Please contact Estie Kahanov for more information at (312) 874 2225. We are happy to accommodate.

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.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Click here to view Terms & Conditions

Yes

PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Camp Gan Israel (CGI) both on and off site, trips, transportation to and from trips etc., unless I advise you otherwise in writing.
Limited Guardianship Approval: I hereby consent that CGI's directors - Rabbi Velvil & Estie Kahanov be granted limited guardianship capabilities with regards to signing waivers on behalf of my child / children for trips specified in this year's camp schedule. (I do understand that I may still be asked to fill out waivers, as not all locations accept this consent)
PAYMENT AND CANCELLATION: Payment terms are a $50.00 non-refundable deposit per camper to accompany registration. The balance is due by June 9, and is non-refundable after that date.
DISMISSAL OF CAMPER: Parent fully understands and agrees that the Camp reserves the right to dismiss, in its sole discretion, any Camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of the Camp or fellow campers or who violates camp rules and regulations. In the event of dismissal, tuition will be refunded on a prorated basis less the $50.00 registration deposit.
IMAGES, ETC.: Permission is hereby given to use in promoting the Camp and in other ventures directly relating to the Camp (i) digital, photographic and video images or likenesses of camper; audio of camper; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by camper or originating from Camp or from a Camp-related activity.
INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Camp Gan Israel (CGI) and its officers, servants or assignees from any liability concerning our child’s involvement in CGI and further agree that the use of any premises during the CGI camp day is made at the risk of the registrant.
I have read and agree to all of the terms and conditions in this Application Form. I am including a non-refundable $50 registration deposit per camper along with submission of this form. I further agree to remit the full tuition and any other fees by June 9 as per the agreed timeline of my choice on this form.

Signature of Parent or Guardian*

Main camp Registration 2026

1. Child/ren’s Information

Child 1

Child 2

Child 3

Child 4

2. Parents Information

Mothers Info:

Fathers Info:

3. Emergency Information

4. Payment Information

5. Terms and Conditions