Campership Fund - Gan Israel Day Camp of Merrick-Bellmore-Wantagh

Before applying for a campership (scholarship), please be aware that the registration process must be completed first. This is done by filling out the camp application form for your child/ren and submitting a deposit. (check or credit card). We will not process the deposit until the campership procedure is completed. Information on camperships will be available one or two months after submitting this campership application. Camperships are granted based on need and on a first come, first served basis. A limited amount is available, so apply early!

Click here to download and print the PDF form.

Child 1:

Full Name*

First Name Last Name

Jewish Name*

First Name Last Name

Age*

Gender*

MaleFemale

Birth Date*

Month Day Year

Child 2:

Full Name

First Name Last Name

Jewish Name

First Name Last Name

Age

Gender

MaleFemale

Birth Date

Month Day Year

Child 3:

Full Name

First Name Last Name

Jewish Name

First Name Last Name

Age

Gender

MaleFemale

Birth Date

Month Day Year

Parents Information

Father's Name*

First Name Last Name

Father's E-mail:*

Mother's Name*

First Name Last Name

Mother's E-mail:*

Please select one*

MarriedDivorcedSeparated

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number*

Area Code Phone Number

Work Phone Number*

Area Code Phone Number

Other Phone

Area Code Phone Number

Occupation*

Employer’s Name*

Employer's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How many children are in your family? *

Which school/s do they go to?*

Which camp did your child/ren go to last summer?*

How many weeks & days will your child/ren attend Gan Israel?*

Did your child/ren go to Gan Israel last summer?*

Why is your situation one of financial hardship?*

Please list 2 references:

Reference 1: Please list name, phone and relationship to you:*

Reference 2: Please list name, phone and relationship to you:*

Household Members & Total Household Income:

Show how often each amount is received. Examples: $100/weekly, $100/bi-weekly, $100/2x per month, $100/monthly If pay period is not noted, we will assume the reported income is received weekly.

List the names of everyone in your household. Earnings from Work, Before Deductions Child Support, Alimony, Etc. Payments from Pension or Retirement Other Income*

SIGNATURE: An adult house member must sign this application. I certify that all of the information is true and that all income is reported. I understand that the information is being given to the camp scholarship committee in order to evaluate the need for a campership discount. I understand that all information submitted will be kept confidential.

SIgnature*

Date*

Month Day Year

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