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Camp Registration Form

Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience with innovative ideas and creative activities, to both provide enjoyment and inspire children!
For dates & rates, click here.
1. Child/ren’s Information
Child 1*
First Name Middle Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Sessions ($225 per session)* $200/week early bird

Week 1 (July 22)Week 2 (July 29)Week 3 (Aug. 5)
Child 2
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Sessions ($225 per session) $200/week early bird

Week 1Week 2Week 3
Child 3
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Sessions ($225 per session) $200/week early bird

Week 1Week 2Week 3
Child 4
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Sessions ($225 per session) $200/week early bird

Week 1Week 2Week 3
2. Parent information
Phone Number

Area Code Phone Number

Address*

Mother's info
First Name Last Name
E-mail* Primary email
Cell Phone

Area Code Phone Number
Father's info
First Name Last Name
E-mail
Cell Phone

Area Code Phone Number
How did you hear of us?
3. Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician & Insurance
First Name Last Name
Phone Number

Area Code Phone Number
Insurance
Policy #
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.
4. Payment Information
Full payment is NOT required at registration.
Please put an amount in the other field for partial payment.
Total: 5% discount for multiple campers

$0.00

I would like to pay today:Full amount$0.00 minimum$

Payment

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Camp Gan Israel of Dayton