Register Online! | Camp Gan Israel of Dayton

	About Our Camp
	Register Online!
	Junior Gan Izzy
	Camp Facility
	Our Staff
	Mission Statement
	Contact Us

Registration for August 2011 is now open! Click here!

This year's camp dates are August 1 through August 12

Online Registration!

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 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	4 & 5 years old		6 & 7 years old	8-11years old
Child 2	4 & 5 years old		6 & 7 years old	8-11years old
Child 3	4 & 5 years old		6 & 7 years old	8-11years old
Please indicate number of weeks and days your child will attend camp:
	Monday Tuesday Wednesday Thursday Friday
Week of...	Week 1 Week 2 August 1 August 8
IMPORTANT
•	All forms must be completed and submitted before your child begins camp.
•	I will be paying by: Check Credit Card
	I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, have photos taken and receive medical care in the case of emergency.
	Comments:

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