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Applications for camp can only be
received at the Chabad office.

For questions or more information
please call the office 516-295-2478

 

 

 

 

 

 

 

 

 

 

Online Registration! Camp Gan Israel 2016 June 28- August 18 Age 24 month - 6 yrs old.
To download form click here

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. PLEASE NOTE: APPLICATIONS ARE BEING ACCEPTED ON A FIRST COME FIRST SERVE BASIS. Space reserved once deposit is received. QUESTIONS? CALL 516-295-2478 EXT. 19.

Note: Please use a separate form for each child.

Child's Information
Name

Child's first name

Last Name

Hebrew Name
 
Address
Street
City
State
Zip
Date of Birth
 
Contact Info
Phone
Email
 
Schools
School
Hebrew School
Entering Grade:
Child's Mother
Mother's Name
Occupation
Work Phone
Cell
Child's Father
Father's Name
Occupation
Work Phone
Cell
Emergency Contact Info
Name

Name
Phone

Phone
Relationship
Relationship
 
Pediatrician
Name
Phone
   
 
Yes my child is/will be toilet trained. All children entering 3 yr old bunk and older must be fully potty trained
Please use the space provided below to describe your child's physical strengths and or weaknesses (physical, emotional, intellectual):
Does your child have any special needs/ services/ therapist we should be aware of?
Does your child have any allergies?
Bunk requests - Please place my child with:
 
Select Child's Age Group (at the start of the summer)
2 yrs. 3 yrs. 4 yrs. 5 yrs. 6 yrs.
   
IMPORTANT
 
Tuition $1,695.00 Early Bird Special $1,595.00
Early bird discount of $100 applies until February 17th.
Sibling discount: $100 for 2nd child
Cannot be combined with Early bird discount.

All forms must be completed and submitted before your child begins camp.
PAYMENT INFO

$500 non refundable deposit reserves a spot if space still available

I will be paying by: Check Cash Credit Card
Last Name First Name
Address
City
State
Zip
Total charge amount Card Type Card Number
Exp. Date
CVV code 3 digits on back of card
Comments
Apply early bird (Before February 17)
Apply $100 off sibling discount for 2nd child (cannot combine with early bird)
Payments are non refundable! I have read the camp brochure and application form and agree to the terms stated.
I give my child permission to receive medical care in the case of emergency.

I give permission for my child’s photo to be used in newspapers / Web / or other public places.
I do NOT give permission
  Date of Application:

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CGI Five Towns 74 Maple Avenue Cedarhurst, NY 11516 516-295-2478
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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