Camp Gan Izzy 2027 Registration - Chabad of NW Bergen County

Summer Camp Enrollment Form 2027
Camp Gan Izzy is BACK for ages 4-1!! Give your child a Jewish experience of a lifetime in a very nurturing environment.
Camper Information
Full Name*
First Name Last Name
Child's Hebrew Name
Date of Birth*

Month Day Year
Age*
Current Grade*
Select Weeks Attending* Early Registration by Nov. 30 $500 per week. $125 per day. After Nov. 30: $600 per week

Week 1 (July 5-9)Week 2 (July 12-16)Week 3 (July 19-22
Does your child have any allergies?* If yes, please specify. If no, please write N/A.
Does your child have any behavioral challenges?* If yes, please specify. If no, please write N/A.
Does your child take any medications?* If yes, please specify. If no, please write N/A.
Parent Information
Father's Name*
First Name Last Name
Mobile*

Area Code Phone Number
E-mail*
Mother's Name*
First Name Last Name
Mobile*

Area Code Phone Number
E-mail*

Home Address*

Emergency Information
Emergency Contact*
First Name Last Name
Relationship to child*
Mobile*

Area Code Phone Number
Pick-up Authorization
Name (other than Parents)
First Name Last Name
Relationship to child
Mobile

Area Code Phone Number
Accident, Field Trip and Privacy Declaration
Trips & Outings

I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program Camp Gan Israel
Agreement*

I Agree
Privacy

I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, Camp Gan Israel's website and social media. I understand that I can withdraw my consent at any time.
Agreement*

I Agree
Accident

As the parent(s) or legal guardian of my/our child, I/we authorize any adult acting on behalf of Camp Gan Israel to hospitalize or secure treatment for my child; I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, camp personnel will try, but are not required to communicate with me prior to such treatment.
Agreement*

I Agree
Payment
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card Paypal

Postal / Zip Code

Country

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Summer Camp Enrollment Form 2027