Registration

Camper Information
Full Name*
First Name Last Name
Birth Date

Month Day Year
Grade*
Allergy Info:
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Choose your child's camp duration:

1 Week2 Weeks3 WeeksChoose Individual Days
Which week?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Which weeks?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Week 1 June 22 - 26

MondayTuesdayWednesdayThursdayFriday
Week 2 June 29 - July 3

MondayTuesdayWednesdayThursdayFriday
Week 3 July 6 -10

MondayTuesdayWednesdayThursdayFriday
Register Additional Child?

YesNo
Full Name*
First Name Last Name
Birth Date

Month Day Year
Grade*
Allergy Info
T-Shirt Size

X-SmallSmallMediumLargeX-Large
Choose your child's camp duration:

1 Week2 Weeks3 WeeksChoose Individual Days
Which week?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Which weeks?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Week 1 June 22 - 26

MondayTuesdayWednesdayThursdayFriday
Week 2 June 29 - July 3

MondayTuesdayWednesdayThursdayFriday
Week 3 July 6 -10

MondayTuesdayWednesdayThursdayFriday
Register Additional Child?

YesNo
Full Name*
First Name Last Name
Birth Date

Month Day Year
Grade*
Allergy Info
T-Shirt Size

X-SmallSmallMediumLargeX-Large
Choose your child's camp duration:

1 Week2 Weeks3 WeeksChoose Individual Days
Which week?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Which weeks?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Week 1 June 22 - 26

MondayTuesdayWednesdayThursdayFriday
Week 2 June 29 - July 3

MondayTuesdayWednesdayThursdayFriday
Week 3 July 6 -10

MondayTuesdayWednesdayThursdayFriday
Register Additional Child?

YesNo
Full Name
First Name Last Name
Grade
Allergy Info
T-Shirt Size

X-SmallSmallMediumLargeX-Large
Choose your child's camp duration:

1 Week2 Weeks3 WeeksChoose Individual Days
Which week?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Which weeks?

Week 1: June 22 - 26Week 2: June 29 - July 3Week 3: July 6 - 10
Week 1 June 22 - 26

MondayTuesdayWednesdayThursdayFriday
Week 2 June 29 - July 3

MondayTuesdayWednesdayThursdayFriday
Week 3 July 6 -10

MondayTuesdayWednesdayThursdayFriday
Parent Information
Legal Guardian*
First Name Last Name
Phone Number*
E-mail*

Address*

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

Emergency Contacts
2 Contacts Required
Full Name*
First Name Last Name
Phone Number*
Full Name*
First Name Last Name
Phone Number*
Releases
As the parent(s) or legal guardian(s) of the above child(ren), I authorize any adult acting on behalf of Camp Gan Israel/Chabad of Riverside to transport my child(ren) using provided transportation. I grant permission for my child(ren) to participate in all off-campus activities and trips.

In the event of an emergency, if I am unavailable, I authorize a representative of Camp Gan Israel/Chabad of Riverside to make any arrangements deemed necessary for my child(ren) to receive medical or hospital care. I agree to assume responsibility for all related charges and expenses for such care and/or treatment. It is understood that when time and circumstances reasonably permit, Camp Gan Israel/Chabad of Riverside personnel will make reasonable efforts to contact me before authorizing treatment, though prior communication is not guaranteed.
*

I agree to the terms and conditions above.
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Camper Information

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Emergency Contacts

Releases

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