Register Online! | Camp Gan Israel Southampton

Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name		First	Middle	Last
Address		Street	City	State	Zip
Date of Birth
Contact Info		Phone	Email
Schools		School	Hebrew School	Entering Grade:
Child's Mother		Mother's Name	Hebrew Name	Work Phone	Cell
Child's Father		Father's Name	Hebrew Name	Work Phone	Cell
Emergency Contact Info		Name	Phone	Relationship
Pediatrician		Name	Phone
Email

Select Child's Age Group
	Ages 2 1/2 - 4 YEARS MINI GAN ISRAEL			Ages 5 -12 YEARS GAN ISRAEL


Please indicate number of sessions your child will attend camp:


IMPORTANT
•	All forms must be completed and submitted before your child begins camp.
•	I will be paying by: Check Mastercard Visa
	I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.

	Date of Application: