Parental and Medical Consent/Financial Agreement

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Your Information
Parent's Name*
First Name Last Name
Parent's E-mail*
Camper's Name*
First Name Last Name
Parental and Medical Consent/Financial Agreement
AUTHORIZED PICKUPS

Please list below caregivers who are authorized to pick up your child.
Full Name
First Name Last Name
Phone Number
E-mail
Full Name
First Name Last Name
Phone Number
E-mail
Full Name
First Name Last Name
Phone Number
E-mail
EMERGENCY INFORMATION

Please provide information for one person in the Hamptons, who we can contact in case

of emergency (if we can’t reach either parent). People listed as emergency contacts are

authorized to pick up your child.
Emergency Contact Name*
First Name Last Name
Emergency Contact Phone Number*
Relationship to Camper*
SUNSCREEN PERMISSION
During camp, the children will be spending lots of time outside. If you would like for us to apply sunscreen to your child, please check this box

I permit staff at Camp Mini Gan Israel to apply the provided sunscreen.
TERMS OF AGREEMENT
1. Full camp tuition is due upon registration

2. Due to the seasonal nature of summer camp and the set limitation of spaces offered, no refund shall be

provided for absences, changes, or withdrawals

3. Permission is granted for the camper to participate in all camp activities.

4. Permission is hereby granted for photographs to be taken of the camper and the camp has the right to utilize those photographs in camp brochures, on our website and in camp print and online advertising
MEDICAL PERMISSION STATEMENT

I hereby give Camp Gan Israel Southampton permission to take my child to any hospital facility or outside doctor when deemed necessary. Furthermore, I hereby give permission to such hospital or outside doctor to authorize x-rays and emergency treatment if deemed necessary. I understand that all medical bills for service rendered are my responsibility.
I have read the terms of agreement and the medical permission statement above and understand its terms and accept its conditions. In the event that this is executed by one parent, I acknowledge that I am also acting as the agent of the other parent with authority to enroll my child at Camp Gan Israel Southampton and to execute this agreement on his or her behalf. I recognize that the Camp relies upon the representation herein made in accepting this enrollment.
I have read the enrollment agreement and understand its’ terms and accept its’ conditions.
I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting "I agree" using any device, means, or action, I consent to the legally binding terms and conditions of this document.
I agree
Electronic Signature*
Today's Date*

Month Day Year
Please note: a camp health form is required to be submitted online for each camper before the start of camp. You may submit the health form by clicking here.
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Your Information

Parental and Medical Consent/Financial Agreement

AUTHORIZED PICKUPS

EMERGENCY INFORMATION

SUNSCREEN PERMISSION

TERMS OF AGREEMENT

MEDICAL PERMISSION STATEMENT

I have read the enrollment agreement and understand its’ terms and accept its’ conditions.

I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting "I agree" using any device, means, or action, I consent to the legally binding terms and conditions of this document.