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Camp Gan Izzy Camper Forms

Camp Registration 2025

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

MaleFemale
Birth date*

Month Day Year
Grade entering Fall 2025*
School 2025-26*
Parent Information
Mother's name*
First Name Last Name
Mother's e-mail*
Mother's cell number*
Father's name*
First Name Last Name
Father's e-mail*
Father's cell 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 16 - June 20Session 2 - June 23 - July 3Session 3 - July 7 - July 18Session 4 - July 21 - August 1
Hot Lunches

$89 per session ($45 mini session)
Extended Care

Before Care - $10 per dayAfter Care - $30 per dayStay & Play - $10 per day
Please list the 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:
** All campers must complete an Emergency Form. Please open this link in a new tab to fill out an Emergency Form for your child.
Payment Information
A $50 non-refundable Registration Fee will be charged upon submission. 50% of the camp fees will be charged by the next business day, with the remaining balance charged in two weeks.
Charge today (non-refundable)*

$50 USD

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 USD
Should be Empty:

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