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Summer Camp Registration Form

Summer Camp Registration Form

New camp families registering before April 7 may initially use the shortened Early Bird Registration Form to get the 10% Discount, Click Here

Campers that attended Summer Camp 2016 may use the Express Registration Form, Click Here

For Dates & Rates please click here


Please note: In order to register a camper we need the following 3 items to be completed :

  1. This form filled out COMPLETELY and SIGNED
  2. $100 Non-refundable deposit and payment plan confirmed
  3. All outstanding balances from previous camps to be paid
Camper 1 Camper 2 Camper 3
Camper's First Name
Camper's First Name
Camper's Fist Name
Camper's Last Name
Camper's Last Name
Camper's Last Name
Hebrew Name
Hebrew Name
Hebrew Name
Age
Age
Age
Date of Birth
Date of Birth
Date of Birth
Born after Sunset
Yes No
Born after Sunset
Yes No
Born after Sunset
Yes No
Gender
Gender
Gender
School Attending
School Attending
School Attending
Entering Grade (Fall 2016)
Entering Grade (Fall 2016)
Entering Grade (Fall 2016)
      
Additional Camper Information
Camper 1 Camper 2 Camper 3
In which extracurricular activities does your child participate throughout the year?
In which extracurricular activities does your child participate throughout the year?
In which extracurricular activities does your child participate throughout the year?
Can your child swim in deep water?
Yes No
Can your child swim in deep water?
Yes No
Can your child swim in deep water?
Yes No
Describe your child's swimming capabilities:
Describe your child's swimming capabilities:
Describe your child's swimming capabilities:
Previous Camps Attended

Previous Camps Attended

Previous Camps Attended

 

Parents' Information
Parents' Status Married Widowed Divorced Separated
Home phone
Home Address
   
 
City
State
Zip
Father
First name
Last name
Hebrew name
 
cell phone
work phone
email
Occupation
   
Mother
First name
Last name
Hebrew name

cell phone
work phone
email
Occupation
   

Is the natural mother of the child/ren Jewish?
Yes No

Were there any conversions or adoptions in the family? 
Yes No 
If yes, please explain: 
 
Synagogue Affiliation:
How did you hear about Camp Gan Israel at The Shul?
 Email/Website Facebook *Friend
  
*Your friend will receive a $50 Referral Bonus (if multiple names are listed, families will split the bonus)
Comments
       

Medical Form

Camper 1 Camper 2 Camper 3

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen 

Motrin - Ibuprofen

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen

Motrin - Ibuprofen 

I hereby authorize CGI at The Shul to give the pain reliever marked below as needed for minor body aches or pain:

Tylenol - Acetaminophen

Motrin - Ibuprofen 


PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication



PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication



PRESCRIPTION MEDICATION:

Name of medication:

Dosage:

Time of Dosage:

Special instructions (e.g. take with food etc.):

Start Date of prescription:

End Date of prescription:

I release Camp Gan Israel at The Shul from any liability from administering this medication


Does your child have any known allergies?

Does your child have any known allergies? 

Does your child have any known allergies? 

Is your child on any medication?
Is your child on any medication? Is your child on any medication?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Are there any medical or behavioral concerns that your child's counselor/s should be aware of?
Emergency Contact Information
Emergency Contact (besides parent)

Phone
Relationship to child
Family Physician
Phone

Release Authorization

In the event that I am not able to pick up my child, he/she may be released only to the following people:

1.   2. 

3.     4

T-Shirts
Please note, for the safety of your child, we require that all campers & staff wear a Camp Gan Israel t-shirt each trip day (usually Tuesdays & Thursdays). While on field trips, camp shirts distinguish our campers and staff from other visitors. Registration includes one t-shirt per camper. T-shirts will be distributed the first day of camp. You may also call to pick up your t-shirt before camp.
Please select your child’s t-shirt size. T-shirts can shrink and tend to run small. When in doubt, order the next size.
Camper 1 Camper 2 Camper 3
X-Small (2-4)
Small (6-8)
Medium (10-12)
Large (14-16)
X-Large (18-20)
X-Small (2-4)
Small (6-8)
Medium (10-12)
Large (14-16)
X-Large (18-20)
X-Small (2-4)
Small (6-8)
Medium (10-12)
Large (14-16)
X-Large (18-20)
If you would like additional t-shirts at a cost of $5 per t-shirt, please indicate below:

How many additional t-shirts would you like?

How many additional t-shirts would you like?

How many additional t-shirts would you like?

Enrollment & Fees

For Dates & Rates please   click here

$100 non-refundable deposit is processed immediately upon submitting this registration form. The office will send you a detailed invoice shortly after you submit this form listing the tuition costs and discounts. Please contact  campganisrael@theshul.net  if you wish to make a different payment plan.

No camper will be turned away due to lack of funds. Please contact  campganisrael@theshul.net  to inquire about our camp scholarships. 

Camper 1 Camper 2 Camper 3
REGULAR CAMP SESSION August 7-24 (Pioneers August 14-24)
  Free Day - August 14, 2017    Free Day - August 14, 2017   Free Day - August 14, 2017
  Full Regular Session - All 3 Weeks (or 2 weeks for Pioneers) Full Regular Session - All 3 Weeks (or 2 weeks for Pioneers) Full Regular Session - All 3 Weeks (or 2 weeks for Pioneers)
Week 1: August 7-11 (not Pioneers) Week 1: August 7-11 (not Pioneers) Week 1: August 7-11 (not Pioneers)
Week 2: August 14-18 Week 2: August 14-18 Week 2: August 14-18
Week 3: August 21-24 Week 3: August 21-24 Week 3: August 21-24
BONUS TRIP WEEK August 28-31
Bonus Trip Week 4: August 28-31 (Cost: $200) Bonus Trip Week 4: August 28-31 (Cost: $200) Bonus Trip Week 4: August 28-31 (Cost: $200)
EXTENDED CARE
We are proud to offer extended care every day from 8:00-9:30 AM and 3:30-6:00 PM (except Friday). The cost is $3/half hour per child. It is assumed that care is needed for all children registered in camp unless specified otherwise below. (The cost for Drop-ins if not pre-registering is $15 for AM and $20 for PM care per child.)
Please note: There is no after-care on Fridays.

If you would like extended care, select which days and hours below:
AM Specify dates:
PM Specify dates:
Comments:
CAMP BBQ

THURSDAY, AUGUST 24

Our annual Camp BBQ will take place this year on on the last day of camp - Thursday, August 24, 2017. Campers will present what they've learned at camp and display their talent to the entire community.
You may pre-register on the registration form or sign up for it later.

Pre-registration cost for camp families:
$12/Adult
$6/Child
$30 (maximum)/family

At the Door:
$15/adult
$10/child


Please indicate number attending:
Adults
Children
Note: when indicating for BBQ here, no need to make separate reservations.

SPONSOR A CAMPER - CAMP GAN ISRAEL SCHOLARSHIP FUND
Yes! I would like to enable another child to enjoy a summer at Camp Gan Israel.
I am enclosing: $200.00 for one week $760 for full summer
Other - $ towards tuition for another camper.
Permission

I hereby permit my child to participate in all activities at Camp Gan Israel at The Shul – on site, off-site and trips. I permit Camp Gan Israel to transport my child(ren) on camp-provided transportation and to obtain emergency medical care as the situation mandates. I release Camp Gan Israel at The Shul and individuals from liability in case of accident during activities related to Camp Gan Israel at The Shul, as long as normal safety procedures have been taken. I allow Camp Gan Israel to photograph and/or videotape my child(ren) to be used on the website, video & any other Camp Gan Israel related publications. I understand that my child may be dismissed during a camp day, due to illness or unacceptable behavior, at the discretion of the camp, and I agree to abide by the director’s decision. I understand that my $100 deposit is non-refundable and that the deposit is processed immediely. I understand that the registration fee is non-refundable, after June 30 the tuition is non-refundable and that refunds will not be made for incomplete attendance. In addition, I understand that submitting a registration form and payment does not guarantee me a spot in camp, and that acceptance into Camp Gan Israel is at the discretion of the camp.

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

Parent/Guardian Date
Payment Details

I will pay:
Full Tuition
Subsidized Tuition

How would you like to pay the tuition cost?
ALL AT ONCE: $100 will be charged now and we will automatically charge the rest when we process the registration
PAYMENT PLAN: $100 non-refundable deposit is due now. Remaining tuition will be split in 2 payments on May 31 and June 30. If you need to set up a different payment plan, it must be coordinated with Director.
Last Name
First Name
Billing Address
City
State
Zip
Current Charge Amount
$
Card Type
Card Number
Exp. Date
    
CVV code - 3 digits on back or card or 4 on front of card for AMEX

Comments
Description of Payment
   
Camp Gan Israel at The Shul
For more information please call 248-788-4000 or email campganisrael@theshul.net

 

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