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Camp Gan Israel Registration Form 5779/2019
Camper's name:
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Family Name:
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Hebrew name:
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Gender
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Male
Female
Age:
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Date of Birth:
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School:
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Grade before summer:
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What time of the day was your child born?
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What city was your child born in?
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Child is in care of:
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Parents
Mother
Father
Guardian
Address:
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Apartment #:
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City:
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Postal Code:
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Father's English name:
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Father's Hebrew name:
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Is the father Jewish:
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Yes
No
Father's cell phone:
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Father's home phone:
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Father's work phone:
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Father's email:
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Mother's English name:
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Mother's hebrew name:
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Is the mother Jewish?
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Yes
No
Mother's cell phone:
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Mother's home phone:
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Mother's work phone
*
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Mother's email:
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Have there been any conversions in the family?
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Yes
No
If yes, please specify:
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Emergency contact's first name:
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Emergency contact's last name:
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Emergency contact's address:
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Emergency contact's cell phone:
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Family doctor's name:
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Family doctor's phone:
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Family doctor's address:
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Sask Health Number:
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Allergies?
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Yes
No
Describe any medical information such as allergies or medication the camp should be aware of :
Please describe any special instructions or needs for your child or any other comments:
Please check off which weeks of camp your child will be attending: Cost is $120/week, $430/all 4 weeks
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Week 1: July 2-5
Week 2: July 8-12
Week 3: July 15-19
Week 4: July 22-26
Will your child need extended care? Cost: Early Care: $25/week, After Care: $25/week
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Yes
No
If yes, please indicate when:
Early Care
After Care
Both Early Care & After Care
Please note: Campers are required to wear their t-shirts every day of camp. Please purchase accordingly.
How many Gan Israel t-shirts will your child need? Cost of t-shirts: $12.50 each.
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We will not need to purchase any
1
2
3
4
Tzitzit: $12/each
1
2
Gan Israel cap: $9.50/each
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2
3
Comments?
*Enrollment in Camp Gan Israel is not a confirmation of the camper's Jewish status.
Please note: A deposit of $100 must accompany each application. The remaining balance MUST be submitted before the beginning of camp. Additionally there is a 5% discount for registrations received before May 14.
Please choose your method of payment:
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Credit card
Cheque
Cash
Terms & Conditions:
Payments:
A deposit of $100 must accompany each application.
All camp fees must be paid in full before the begininng of camp, July 2.
Images:
Camp Gan Israel is hereby granted permission to use any individual or group photo or video showing our child/ren involved in camp activities.
Damage:
As parents or guardians, we agree that we will be responsible for any loss, damage or destruction by our camper to any property of Camp Gan Israel or to any property for which the camp is liable or chargeable.
Permission to participate:
We give permission for our child to participate in all camp activities and trips.
Medical Care:
We have filled out our child's medical information. In the event that medical attention is required, I hereby authorize any licensed physician or medical provider to administer any and all medical treatment deemed necessaey for the well-being of my child.
I have read and accept all of the terms and conditions set forth on this registration form.
Date:
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Parent/guardian signature:
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