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Campers Application Form

Camp Gan Israel Registration
Summer 2019
Camp Dates: Monday, June 24th thru Friday, July 5th
Camper Information
Camper Name
First NameLast Name

Address

Home Phone
Area CodePhone Number
Birth Date
MonthDayYear
Hebrew Name
School
Grade entering in September
T-shirt Size
Parent Information
Mother's Name
Cell Number
Area CodePhone Number
E-mail
Father's Name
Cell Number
Area CodePhone Number
E-mail
Parent's Marital Status
Emergency Contact
Name
Relation to Camper
Cell Number
Area CodePhone Number
Dates & Rates
$70 per day or $300 per entire week
A limited amount of scholarships are available thanks to the Dr. Arnold Glaubman Scholarship Fund. Please email avremi@jewishutah.com for scholarship info.
I would like to send my child for:
Monday, June 24thTuesday, June 25thWednesday, June 26thThursday, June 27thFriday, June 28thWeek 1 - Monday-FridayMonday, July 1stTuesday, July 2ndWednesday, July 3rdThursday, July 4thFriday, July 5thWeek 2- Monday-FridayFull Summer Season: Monday, June 24 - Friday, July 5th
Total amount to be charged to my card:

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Terms and Conditions*
I acknowledge that 50% of my tuition payment is non-refundable as the Registration Fee. The remaining 50% becomes non-refundable on June 1, 2019.
Should be Empty:

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