1. Camper Information AGES 3 - 11 ONLY (No Exceptions) Kid's have to be Potty Trained We are a NUT FREE Camp Week 5 & 6 SOLD OUT FOR 3 YEAR OLDS Week 5 & 6 SOLD OUT FOR 4 YEAR OLDS --> Please request to be added to our Waitlist First Child's Name* First Name Last Name Age as of July 1st* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade Entering* PreschoolPre-KKindergarten123456 Does Your Child Attend Preschool of the Arts YesNo Does Your Child Attend Chabad JCC Hebrew School YesNo ADD Second Child Yes Second Child's Name First Name Last Name Age as of July 1st Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade Entering NurseryPreschoolKindergarten123456 ADD Third Child Yes Third Child's Name First Name Last Name Age as of July 1st Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade Entering NurseryPreschoolKindergarten123456 ADD Fourth Child Yes Fourth Child's Name First Name Last Name Age as of July 1st Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade Entering NurseryPreschoolKindergarten123456 ADD Fifth Child Yes Fifth Child's Name First Name Last Name Age as of July 1st Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade Entering NurseryPreschoolKindergarten123456 Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country 2. Parent Information: Mother's Name* First Name Last Name Cell Phone Number* E-mail* Father's Name* First Name Last Name Cell Phone Number* E-mail* 3. Emergency Contact Information Emergency Contact Name* First Name Last Name Relationship to Child* Cell Phone Number* Children's Primary Physician's Name* Physicians Phone #* Children's Dentist Name* Dentist Phone #* Health Insurance Provider:* Insurance ID:* 4. Additional Camper Information: Additional People Authorized to Pick Up:* Which Activities Does Your Child Enjoy? Briefly Describe Your Childs Personality: Is There Anything Special That We Should Know About Your Child (Allergies, etc)? Comments 5. Camp Tuition: $ 600 / Week (No Single Days Available) Select the Weeks Your FIRST Child Will Be Attending: $ 600 / Week Week 1 (June 29 - July 3)Week 2 (July 6 - July 10)Week 3 (July 13 - July 17)Week 4 (July 20 - July 24)Week 5 (July 27 - July 31) - Don't Register if your Child is 3 or 4Week 6 (August 3 - August 7) - Don't Register if your Child is 3 or 4 Select the Weeks Your SECOND Child Will Be Attending: $ 600 / Week Week 1 (June 29 - July 3)Week 2 (July 6 - July 10)Week 3 (July 13 - July 17)Week 4 (July 20 - July 24)Week 5 (July 27 - July 31) - Don't Register if your Child is 3 or 4Week 6 (August 3 - August 7) - Don't Register if your Child is 3 or 4 Select the Weeks Your THIRD Child Will Be Attending: $ 600 / Week Week 1 (June 29 - July 3)Week 2 (July 6 - July 10)Week 3 (July 13 - July 17)Week 4 (July 20 - July 24)Week 5 (July 27 - July 31) - Don't Register if your Child is 3 or 4Week 6 (August 3 - August 7) - Don't Register if your Child is 3 or 4 Select the Weeks Your FOURTH Child Will Be Attending: $ 600 / Week Week 1 (June 29 - July 3)Week 2 (July 6 - July 10)Week 3 (July 13 - July 17)Week 4 (July 20 - July 24)Week 5 (July 27 - July 31) - Don't Register if your Child is 3 or 4Week 6 (August 3 - August 7) - Don't Register if your Child is 3 or 4 Select the Weeks Your FIFTH Child Will Be Attending: $ 600 / Week Week 1 (June 29 - July 3)Week 2 (July 6 - July 10)Week 3 (July 13 - July 17)Week 4 (July 20 - July 24)Week 5 (July 27 - July 31) - Don't Register if your Child is 3Week 6 (August 3 - August 7) - Don't Register if your Child is 3 Additional Days - Only if Preapproved $130 / Day Total $0.00 For Scholarship Request Click Here Informed Consent & Acknowledgement:* As the parent(s) or legal guardian(s) of the child/ren noted above, I give permission for my child to participate in all camp activities, both on-site and off-site. I understand that normal camp activities involve some risk, and I agree that Camp Gan Israel, the Chabad JCC, its staff, and volunteers are not responsible for ordinary accidents or injuries that may occur. I give permission for my child to travel on field trips using RFTA public buses and camp-rented passenger vans driven by approved staff or contractors. I understand that transportation carries some risk and that staff follow all required safety procedures. In the event of illness or injury, I authorize camp staff to provide basic first aid, contact emergency services, and allow my child to be transported for medical care if needed. I agree to be responsible for any related medical expenses. I also give permission for my child to be photographed or filmed during camp activities and for these images to be used in camp newsletters, updates, and promotional materials used by Chabad JCC. Names will not be used without additional consent. Confirmation* By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature. Print Name* First Name Last Name Please download the Health & Immunization Form and email a pediatrician signed form to: [email protected] by June 1st, 2026 - We require these for any children under the age of 4. Health & Immunization Form Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Cancelation policy: 3% non-refundable deposit at time of booking to cover our credit card fees. 50% of tuition non-refundable if canceled after June 1. 100% is non-refundable within 7 days of booked camp start dates. 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