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Camp Gan Israel Registration
Family Information

Address*

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

Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's E-mail
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's E-mail
Best way to send CGI updates:*

Cell PhoneEmail
I am willing to assist in CGI activities, please contact me
How many children would you like to register?*
Camper Information
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Grade entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Please select which weeks to register for:

Week 1 (June 24 - June 28)Week 2 (July 1 - July 5)
Camper 2 Information
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Grade entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Please select which weeks to register for:*

Week 1 (June 24 - June 28)Week 2 (July 5 - July 8)
Camper 3 Information
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Grade entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Please select which weeks to register for:*

Week 1 (June 24 - June 28)Week 2 (July 5 - July 8)
Emergency Contact
Full Name*
First Name Last Name
Phone Number*
Relationship*
Pediatrician*
Pediatrician Phone *
Payment
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Name on Card
Expiration Month	Expiration Year

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Street Address

City

State / Province

Postal / Zip Code

Country

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Camp Gan Israel Registration

Family Information

Camper Information

Camper 2 Information

Camper 3 Information

Emergency Contact

Payment