*** For Registrations Submitted After Friday, June 23rd at Noon MST - Please also contact Leah Engel directly at (720) 363-1088 to confirm your registration ***

$45 non-refundable registration fee per camper due with registration.

Family Information
Family Name
        
Address
   Street
City
State
Zip
Contact Info
   Home Phone
Email
Mother
   Mother's Name
Hebrew Name
Work Phone
Cell
Father
   Father's Name
Hebrew Name
Work Phone
Cell
Emergency Contact Info
   Name
Phone
Relationship
 
 
   Name
Phone
Relationship
 
Pediatrician
   Name
Phone
Insurance Policy #
           
Camper 1 Information
      
Name
   First Name
Middle Name
Gender
 
Date of Birth
   Jewish Bday
Schools
   School
Entering Grade:
 
Health Notes
   Medication
Allergies

Sessions Attending
  
 
           
Camper 2 Information
      
Name
   First Name
Middle Name
Gender
 
Date of Birth
   Jewish Bday
Schools
   School
Entering Grade:
 
Quick Health Notes
   Medication
Allergies

Sessions Attending
  
 
           
Camper 3 Information
      
Name
   First Name
Middle Name
Gender
 
Date of Birth
   Jewish Bday
Schools
   School
Entering Grade:
 
Health Notes
   Medication
Allergies

Sessions Attending
  
 
     
IMPORTANT
•
 All forms must be completed and submitted before your child begins camp.
Name on Card
  
Card Number
  
Expiration
  
CVV Code
   What's This?
  I authorize Camp Gan Israel to charge my card non-refundable registration fees in the amount of $

I understand that the weekly fee of $185.00 is due each Monday. I agree to indemnify and hold harmless Gan Israel and its employees in case of injury, G‑d forbid. I gave my child permission to participate in all activities and for medical treatment to be administered in case of emergency.

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