Register Online! | Camp Gan Israel of Dayton

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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, 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 23 July 30 August 6
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 • • ,
A branch of the world's largest Jewish Camping network, Camp Gan Israel International