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Community Children & Family Events Camp Gan Israel

Camp Registration

Camper Info
Child's Name*

First Name Last Name
Birth Date*

Month Day Year
Parent's Info
Parent 1*

First Name Last Name
Email*
Cell

Area Code Phone Number
Parent 2

First Name Last Name
Email
Cell

Area Code Phone Number
Medical & Emergency Info
Child's Doctor
Phone Number

Area Code Phone Number
Does your child have any medical conditions?

YesNo
Please describe your child's medical conditions*
Does your child take any medication?*

YesNo
Please list the medications your child takes*
Does your child have any allergies?*

YesNo
Please list your child's allergies*
Emergency Contact

First Name Last Name
Phone Number

Area Code Phone Number
I, the undersigned parent/guardian authorize all camp staff to
1. In case of serious illness/accident to treat camper at the nearest hospital
2. To transport camper in camp bus, van or private vehicle
3. Camper has my permission to participate in all camp activities.
Agreement*

I authorize the Camp to take necessary medical measures as outlined in the terms above.
Billing Info

Payment

Credit Card Check

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

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