Camp Registration Form

Camp Gan Israel is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. CGI is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative activities, to both provide enjoyment and inspire children to try new and exciting things!

Camp dates July 1 - August 2.

Child 1*

First Name Middle Name Last Name

Age

Birth Date*

Month Day Year

Gender*

MaleFemale

Session/s*

Would you like to sign up another child?

YesNo

Child 2

First Name Middle Name Last Name

Age

Birth Date

Month Day Year

Gender

MaleFemale

Session/s

Would you like to sign up another child?

YesNo

Child

First Name Middle Name Last Name

Age

Birth Date

Month Day Year

Gender

MaleFemale

Session/s

Would you like to sign up another child?

YesNo

Child

First Name Middle Name Last Name

Age

Birth Date

Month Day Year

Gender

MaleFemale

Session/s

Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's info

First Name Last Name

Work Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

E-mail Primary email

Is the natural mother of the child Jewish by birth?**

yesno

Is the natural mother of the child a Jewish convert?**

yesno

Please upload conversion documentation

Father's info

First Name Last Name

Work Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

E-mail

Is the natural father of the child Jewish by birth?**

yesno

Emergency Contact*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship*

Pediatrician

First Name Last Name

Phone Number

Area Code Phone Number

Please list any serious illnesses your child/ren has had in the past six months, including noting any history of physical handicaps, rheumatic fever, heart problems, seizures, asthma, diabetes, or other problems.

Does your child have any allergies?

YesNo

Please describe the allergy and indicate special precautions or care as needed

Please describe any instructions that would be helpful in caring for , or special medical information needed by the child's care staff/provider

Name of person who will be picking up my child from camp

*I have read the camp brochure and application form and agree to the terms stated. I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation, and to obtain emergency medical care as the situation mandates.

In the event of an accident, if we feel that your child should receive medical attention, he/she will be taken directly to Bumrungrad Hospital (Sukhumvit Soi 3) or Samitivej Hospital (Sukhumvit Soi 49). You will be contacted by phone to go to the hospital as soon as possible. It is understood Camp Gan Israel Chabad will not be responsible for any medical costs incurred.

I understand that full payment is due before June 20. Refunds will not be made for incomplete attendance.

Camp Gan Israel will make every effort to ensure the safety and wellbeing of every camper. However, the camp will not be held liable for any injury or loss/damage of personal property.

I give my child permission to attend all trips.

The parent who signs this registration form represents that he/she has full authority to do so.

*Please note that a payment form will be emailed to you once you receive your acceptance letter

Parents Signature*

Date of Signature*

Camp Gan Israel of Thailand

Dedicated in memory of Moshe and Keshvar Kashani

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Health Information

5. Signature

Camp Address