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Old Camp Gan Izzy

Camp Registration 2024

Camper's Information
Child's name
Last Name First Name
Gender

MaleFemale
Birth date

Month Day Year
Grade entering 2024-25
School 2024-25
Parents' Information
Mother's name
First Name Last Name
Mother's e-mail
Mother's cell number

Area Code Phone Number
Father's name
First Name Last Name
Father's e-mail
Father's cell number

Area Code Phone 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 17 - June 21Session 2 - June 24 - July 5Session 3 - July 8 - July 19Session 4 - July 22 - August 2
Extras

Lunches- $79 per session ($39 mini session)Before Care - $10 per dayAfter Care - $20 per day
Please list approximate days of the week that 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 $50 non-refundable Registration Fee will be charged today. 50% of the camp fees will be automatically charged upon processing the registration, and the remainder will be charged in 2 week's time.
Charge today (non-refundable)*

$50

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

City

State / Province

Postal / Zip Code

Country

Total

$0.00
Should be Empty:

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