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Camp Registration 2023

Camper's Information
Child's name
Last NameFirst Name
Gender
MaleFemale
Birth date
MonthDayYear
Grade entering 2023-24
School 2023-24
Parents' Information
Mother's name
First NameLast Name
Mother's e-mail
Mother's cell number
Area CodePhone Number
Father's name
First NameLast Name
Father's e-mail
Father's cell number
Area CodePhone Number

Home address

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

Are parents divorced?
NoYes
If yes, explain custody arrangement:
Camp Options
Class Option*
Grades K - 3Grades 4 - 7
Sessions*
Session 1 (mini) - June 12 - June 16Session 2 - June 19 - June 30Session 3 - July 3 - July 14Session 4 - July 17 - July 28
Extras
Lunches- $69 per session ($35 mini session)Before Care - $5 per dayAfter Care - $15 per day
Please give estimate of days extended care will be needed
Are you a first time camper at Camp Gan Izzy?
YesNo
If yes, whom can we thank for referring you?
Notes:
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Please open this link in a new tab to fill out the Emergency Form for your child.
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Payment Information
A $100 Registration Fee will be charged today. 50% of the camp fees will be automatically charged on February 1st and the remainder on April 28th.
Charge today
$100

Credit Card Info*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Total
$100.00
Should be Empty:

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