Child's Last Name
Child's First Name
Child's Full Hebrew Name (type in english)
Age as of July 1st
Child's Date of Birth

(Don't Know the Jewish Birthday? Click Here)
Grade Entering
 
Address
City
State
Postal Code
Phone
Email
   
Mother's Name

Email 
 Mobile Phone 


  
 
Father's Name
Email 
Mobile Phone 


  
   
Emergency Contact Name
Work Phone 
Mobile Phone 


  
Physician or Medical Facility Name
Phone
   
School Child is Now Attending
Hebrew School
Previous Camps Attended
Which Activities Does Your Child Enjoy?
In Which Extracurricular Activities Does Your Child Participate Throughout The Year?
Brieflly Describe Your Childs Personality:
Is There Anything Special That We Should Know About Your Child (Allergies, etc.)?
Comments
   

$65/Day =

$275/Week  = 
Please select the dates your child will be attending:
Monday, 7/29 Tuesday, 7/30 Wednesday, 7/31 Thursday, 8/1 Friday, 8/2
Monday, 8/5 Tuesday, 8/6 Wednesday, 8/7 Thursday, 8/8 Friday, 8/9
Week 1: 7/9 - 8/2 Week 2: 8/5 - 8/9            
*Discounts for kids enrolled in our Hebrew School
   
Payment Type
Credit Card
Check (Please make all checks payable to Jewish Community Center
First Name
Total Amount
Last Name
Credit Card Type
Address
Credit Card Number
City
Expiration Date
State
CVV Security Code
Postal Code
Comments
   

I herby give my child permission to participate in all activities at Camp Gan Israel Day Camp - on-site, off-site and trips. I give permission that any photos taken of my child during camp hours may be used for publicity purpose.

The parent to sign the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fee.

Sign Name: Date:

Camp Office is 435 West Main Street • Aspen, CO 81611
Feel Free to Call 970-544-3770