Registration for Summer 2019 is Now Open!!
Click here to print an application
Click to view camp fees for CGI 2019
Note: Please use a separate form for each child.
Please fill out this form as an initial registration for the Camp Gan Israel.
Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance email is received.
Last Name: First Name: Hebrew Name:
What school does your child attend? Grade Entering
Synagogue affiliated with:
Is the natural mother of the child Jewish? Yes No
Were there any conversions or adoptions in your family? Yes No
If yes, please describe:
Any special considerations, such as a learning disorder or any cognitive difficulties, that the camp
should be aware of? (Confidential):
Father's Name: Father's Phone:
Mother's Name: Mother's Phone:
Home Address (Street, City, State, Zip)
Emergency Contact Information
Please list two contacts to be used in case of emergencies.
Full Name: Phone:
Relationship to Child:
Second Emergency Contact
Full Name: Phone:
Relationship to Child:
Child's Physician or Medical Facility
Up to date with vaccinations? Yes No
Date of last tetanus shot:
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
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. 3. 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 his fellow campers or who violates camp rules and regulations.In the event of dismissal, tuition will be refunded on a prorated weekly basis less the registration deposit. 4. MEDICAL CARE: In case of emergency, I hereby give permission to the physician selected by the camp director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an M.D. as named on this form or if unavailable another M.D.. Every effort will be made to contact the parent / guardian and emergency contacts first. Should it be necessary for the well being of the camper to utilize outside medical or dental services all expenses involved will be paid for by the Parent. To the best of my knowledge, my child is in good health and I will notify the camp if he/she is exposed to any infectious diseases. I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the Director’s decision. 5. 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. 6. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Camp Gan Israel (CGI) and its officers, servants or assigns 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.
Accept Do Not Accept
Camp Gan Israel Tuition Agreement
to view a full printout of fees, options, terms and conditions. Please note a $75 registration fee must accompany all applications for a spot to be reserved for you child.
I have downloaded & read the full schedule of fees and agree to abide by them.
Name of Cardholder:
Card Number: Expiration: CVV:
Billing Address (Street, City, Sate, Zip)
Sessions: Week One Week Two Week Three Full Summer
Free T-Shirt Size:
I would extra shirts ($12 each).