Registration

Full Name*

First Name Last Name

Age*

Grade*

T-Shirt size

Attending:*

Week 1Week 2Week 3

Full Name

First Name Last Name

Age

Grade

T-Shirt size

Attending:

Week 1Week 2Week 3

Full Name

First Name Last Name

Age

Grade

T-Shirt size

Attending:

Week 1Week 2Week 3

Legal Guardian*

First Name Last Name

E-mail*

Mailing Address*

Street Address
Street Address Line 2
City	State
Zip Code	Country

Emergency Contact #1*

First Name Last Name

Phone Number*

Area Code Phone Number

Emergency Contact #2

First Name Last Name

Phone Number

Area Code Phone Number

Allergy Info: Please provide any allergy or other medical information we should be know about:

Camp Dates: June 26 - July 14

Early Bird Pricing:
One Week: $219 - Register by April 1st $199
Two Weeks: $419 - Register by April 1st $379

Full Session: $619 - Register by April 1st $579

Individual Days: $50 per day - Register by April 1st $45
Discounts: Sibling Children additional 5% discount

Camp Fees:
One Week: $219
Both Weeks: $419

Individual Days: $50 per day
Discounts: Sibling Children additional 5% discount

Select week(s)

Week 1Week 2Week 3

Individual Days

I would like to sign up for individual days

Select Individual Days for week 1

Select Individual Days for week 2

Select Individual Days for week 3

No Camper will be turned away due to lack of funds. Scholarships are available. Please Click Here to fill out a Scholarship Application Form.

Amount to charge today (minimum $50):*

$

Please charge the balance monthly:

Over 4 monthsOver 6 monthsOver 8 months

Total

$0.00

Payment*

Credit Card Paypal

Postal / Zip Code

Country

Releases: As the parent(s) or legal guardian of the above child/ren, I authorize any adult acting on behalf of Camp Gan Israel/Chabad of Riverside to transport my child/ren by means of transportation provided. My child/ren is/are allowed to participate in all off campus activities and trips. In the event of an emergency, when I am not available, I authorize a representative of Cam Gan Israel/Chabad of Riverside to make such arrangements as considered necessary, to receive medical or hospital care. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit Camp Gan Israel/Chabad of Riverside personnel will try, but are not required, to communicate with me/us prior to such treatment.

*

I agree to the terms and conditions above.

Type Initials:*

Comments:

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Campers Information

Parents Information

Payment Information