Registration - JewishChulaVista.com

CHILD 1 INFORMATION

Full Name*

First Name Last Name Age

Birth Date*

Month Day Year

Gender*

Male Female

Does your child have any allergies?

Sessions* $200 per session, or $360 for both sessions | EARLY BIRD until March 31, $175 per session, or $315 for both sessions

Week 1 (July 1-5) - EARLY BIRD $175 Week 2 (July 8-12) - EARLY BIRD $175 Weeks 1&2 (July 1-12) - EARLY BIRD $315

Sessions $200 per session, or $360 for both sessions

Week 1 (July 1-5) - $200 Week 2 (July 8-12) - $200 Weeks 1&2 (July 1-12) - $360

CHILD 2 INFORMATION

Full Name

First Name Last Name Age

Birth Date

Month Day Year

Gender

Male Female

Does your child have any allergies?

Sessions 10% Sibling Discount | $180 per session, or $324 for both sessions | EARLY BIRD until March 31, $157 per session, or $283 for both sessions

Week 1 (July 1-5) - EARLY BIRD $157 Week 2 (July 8-12) - EARLY BIRD $157 Weeks 1&2 (July 1-12) - EARLY BIRD $283

Sessions 10% Sibling Discount | $180 per session, or $324 for both sessions

Week 1 (July 1-5) - $180 Week 2 (July 8-12) - $180 Weeks 1&2 (July 1-12) - $324

CHILD 3 INFORMATION

Full Name

First Name Last Name Age

Birth Date

Month Day Year

Gender

Male Female

Does your child have any allergies?

Sessions 10% Sibling Discount | $180 per session, or $324 for both sessions | EARLY BIRD until March 31, $157 per session, or $283 for both sessions

Week 1 (July 1-5) - EARLY BIRD $157 Week 2 (July 8-12) - EARLY BIRD $157 Weeks 1&2 (July 1-12) - EARLY BIRD $283

Sessions 10% Sibling Discount | $180 per session, or $324 for both sessions

Week 1 (July 1-5) - $180 Week 2 (July 8-12) - $180 Weeks 1&2 (July 1-12) - $324

ADDRESS

Address*

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

PARENT'S INFORMATION

Father's Name*

First Name Last Name

Was father born Jewish?

Father's Cell*

Area Code Phone Number

Father's E-mail*

Mother's Name*

First Name Last Name

Was mother born Jewish?

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

EMERGENCY INFORMATION

Emergency Contact*

First Name Last Name Relationship

Phone Number*

Area Code Phone Number

Doctor

First Name Last Name

Doctor's Phone Number

Area Code Phone Number

Does your child have any medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

MORE INFORMATION

Briefly describe your child/ren's personality

Are you interested in more info about early & after care?

How did you hear about Camp Gan Israel?

Terms of Agreement**

I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

Synagogue membership is NOT required. Please note, that no child will be turned away due to lack of funds. Please contact us to discuss any financial considerations.

PAYMENT INFORMATION
20% minimum payment required at registration.
The first 20% payment will also be used as your non refundable deposit.
Full balance must be paid in full by June 1

Total

$0.00

I would like to pay today: Full amount 20% minimum: $0.00 $

Payment

Credit Card Paypal Check/Cash