Gan Izzy Registration 2023

Child Information

Child's First Name

Child's Last Name

Gender

Date Of Birth

Jewish Birthday

Grade Entering

T-shirt Size

Parent # 1 Information

First Name

Last Name

Phone

Parent # 2 Information

First Name

Last Name

Phone

Address

City

State

Zip

Health Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Cell Phone

Physician or Medical Facility

List any illnesses your child had within past 6 months

List any Sensitivities your child has. Any dislikes you feel we should be aware of?

Does your child have any allergies?

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

Does your child have a history of: None, Heart problems, Physical handicaps, Rheumatic fever, Heart problems, Seizures, Asthma, Diabetes, Other Medical history - Please Describe:

Swimming Checklist

The checklist below is a list of skills required for each swimming level. These skills correspond to the American Red Cross Swimming Program. Please check the level corresponding to the skills your child has. This checklist will help us to place your child in the most appropriate level.

Parental Consent

I hereby give my consent for emergency medical treatment, to be used only if I cannot be reached immediately.

I hereby give permission for my child to be transported and participate in field trips during operating hours. Details will be sent to me in advance

I hereby authorize Camp Gan Israel to transport my child between the central pickup point and the camp location, Eastside Torah Center and Chabad of the Central Cascades.

I hereby authorize my child's photo to be used for marketing purposes

In the event that I am not at drop off the driver is authorized to leave my children with:

Phone Number For Alternative Drop-off

If the above mentioned adult is not at home, follow these procedures

Weeks Attending

The early bird price for camp is $350 per week. Price will go up to $375 per week after March 1st. (Security Included)

Weeks Attending:

First Week: July 3 - July 7 (Add me to the Waitlist)

Second Week: July 10 - July 14 (Add me to the Waitlist)

Third Week: July 17 - July 21 (Add me to the Waitlist)

Fourth Week: July 24 - July 28 (No camp July 27th for Tisha Beav) (Add me to the Waitlist)

Fifth Week: July 31 - August 4 (Add me to the Waitlist)

Gan Izzy Day camp Terms and conditions

I read and agree to the Gan Izzy Day Camp terms & conditions

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