Apply for Camp Gan Izzy

1. If you haven't yet, please review our Camp Dates and Rates before applying here.
2. You will be required to pay the registration fee (per child) to submit this application.
After submitting this application, it will be reviewed by our administration office.
Please look out for any correspondence and our letter of acceptance.

Full Name Name of Parent/Guardian filling out this application

First Name Last Name

Email* For application confirmation and status

Phone Number*

Address*

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

How many children are you applying to CGI?*

If you have more than 4 children please contact us.

Child 1*

First Name Hebrew Name Last Name

Birth Date* child 1

Month Day Year

Gender* child 1

MaleFemale

Sessions* child 1

Week 1Week 2Week 3Week 4

Child 2*

First Name Hebrew Name Last Name

Birth Date* child 2

Month Day Year

Gender* child 2

MaleFemale

Sessions* child 2

Week 1Week 2Week 3Week 4

Child 3*

First Name Hebrew Name Last Name

Birth Date* child 3

Month Day Year

Gender* child 3

MaleFemale

Sessions* child 3

Week 1Week 2Week 3Week 4

Child 4*

First Name Hebrew Name Last Name

Birth Date* child 4

Month Day Year

Gender* child 4

MaleFemale

Sessions* child 4

Week 1Week 2Week 3Week 4

Mother's info

First Name Hebrew Name Last Name

Work Phone

E-mail

Cell Phone

Father's info

First Name Hebrew Name Last Name

Work Phone

E-mail

Cell Phone

Phone Number*

How did you hear of us?

Is child's natural mother jewish?*

YesNo

Is child's natural father jewish?*

YesNo

Have there been any conversions or adoptions* Grandparents included

Yes (Please specify)No

Comments

Any allergies or concerns*

Yes - Please specifyNo

Allergy Info

Emergency Contact*

First Name Last Name

Relationship*

Pediatrician & Insurance

First Name Last Name

Phone Number

Insurance

Policy #

Time of submission

Month Day Year

at Hour Minutes

$85 Non-refundable registration fee* $35 goes towards camp tuition

$85 - 1 Child$170 - 2 Children$255 - 3 Children$340 - 4 Children

$135 Non-refundable registration fee* $35 goes towards camp tuition

$135 - 1 Child$270 - 2 Children$405 - 3 Children$540 - 4 Children

Non-refundable Registration is automatically added to you total below
($35 of registration fee is applied to camp tuition)
$85 per camper for early bird submissions.
$135 per camper for non early bird

Camp tuition: see Dates & Rates

Tuition Agreement*

I have reviewed the tuition rates listed in the Dates & Rates page and agree to pay the amount for my child/ren to attend Camp Gan Izzy

Tuition* Amount of tuition I want to pay now (in addition to registration)

$0

Total

$0.00

Payment

Credit Card Paypal

Postal / Zip Code

Country

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. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

General comments

Congratulations! You are about to give your child the ultimate Jewish camping experience!

Your Info

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information