Gan Israel Summer Program Online Registration

Please complete the form below carefully. This form is good for up to 3 children. When you press submit, this form will be sent to our administrative office.

PLEASE NOTE:
APPLICATIONS ARE BEING ACCEPTED ON A FIRST COME FIRST SERVE BASIS.
Space is reserved once deposit is received.

QUESTIONS? CALL 866-422-6744

1. Camper's Name:
  Hebrew Name  
  Nickname
  Gender & DOB M F
  Grade Fall 2019
  New/Returning New Camper Returning Camper
  Age Group
  Sessions
  If needed, please specify dates here:
  Times
  Days
  Before Care? Specify Hours
  After Care? Specify Hours
    Any special concerns/allergies/requests regarding camper?
 
2. Camper's Name:
  Hebrew Name
  Nickname
 
 Gender & DOB M F
  Grade Fall 2019
  New/Returning New Camper Returning Camper
  Age Group
  Sessions
  If needed, please specify dates here: 
  Times
  Days
  Before Care? Specify Hours
  After Care? Specify Hours
    Any special concerns/allergies/requests regarding camper?
 
3. Camper's Name:
  Hebrew Name
  Nickname
 
 Gender & DOB M F
  Grade Fall 2019
  New/Returning New Camper Returning Camper
  Age Group
  Sessions
  If needed, please specify dates here:
  Times

  Days

  Before Care? Specify Hours
  After Care? Specify Hours
    Any special concerns/allergies/requests regarding camper?

Family Information
  Mother's Name
  Mother's Cell
  Mother's Work
  Father's Name
  Father's Cell
  Father's Work
 
 Street Address
  City/State/Zip
  Home Phone
  E-mail
  Referred by
 

Discount

Additional Comments or Requests

 
Important Information
 

An $85 application fee per family & $150 deposit per child is required to reserve a space for your child. Balance is due by May 11th, 2020. In the event full payment is not received by May11th, 2020, your credit card will be charged for the balance of the fee. There is a 2.5% charge added for credit card payments.

  I have read the camp's terms and conditions and agree to the terms and conditions stated.
 
Payment Information

Payment Method   Check* Credit Card (2.5% fee for all CC transactions)
*Please note that your child's registration is not complete, and space is not being held, until payment is received.
  Name on Card
  Card #
  Card Type/Exp. Date
  CVV Number
  Payment Terms Charge my card the full amount
Charge my card the $85 registration fee plus a $150 deposit per child & charge the balance in 2 parts (on March 9th and May 11th).
I will send a check payment.
  Discount  Yes! Please apply the 20% discount to my camp payment.