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Online Registration!

For Dates and Rates please click here.

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please print the medical, swimming and release form, and mail! Click for the forms.

Camper/Parent Information
Name
  First
Middle
Last
 
Name
  First
Middle
Last
 
Name
  First
Middle
Last
 
Address
  Street
City
State
Zip
Date of Birth
   
Date of Birth
   
Date of Birth
   
 
Contact Info
  Home Phone
Email

 
Schools
  School
Hebrew School Grade Entering:
Child's Mother
  Mother's Name
Hebrew Name Work Phone Cell
Child's Father
  Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info 1
  Name

Phone

Relationship
 
Emergency Contact Info 2
 

Name

Phone
Relationship
 
Pediatrician
  Name

Phone

   
           
Select Child's Age Group
Child 1
 PreK
6-8 years old
9-11 years old  
Child 2
 PreK
6-8 years old
9-11 years old  
Child 3
 PreK 6-8 years old 9-11 years old  
Please indicate number of weeks and days your child will attend camp:
 

Monday Tuesday Wednesday Thursday Friday

Week of...

Week 1 Week 2 Week 3
July 24            July 31        August 7

IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Check Credit Card
   
  Comments:
   
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Camp Gan Israel of Dayton 2001 Far Hills Avenue Dayton, OH 45419 937-643-0770
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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