Gan Israel Day Camps 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 processed on a 'first come, first served' basis.
Your spot is only confirmed once deposit and full payment is received and you receive a confirmation from our office.

QUESTIONS? CALL 516-833-3057 ext 108. 

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 non-refundable application fee per family & non-refundable $150 deposit per child is required to reserve a space for your child. Balance is due by June 20th, 2020. In the event full payment is not received by June 20th, 2020, your credit card will be charged for the balance of the fee. There is a 2.5% charge added for credit card payments.

   Checking this box is my signature and confirmation that I have read and agree to the camp's terms and conditions, the Covid-19 Prevention Plan, and the Parent Waiver.
 
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 reserved for camper 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 on June 20th.
I will send a check payment.