Camp Gan Israel 2022 - Registration Form

Number of children*

Name*

Child First Name Child Last Name

Hebrew & Nickname*

First Name Nickname

Gender*

MaleFemale

Birth Date*

Month Day Year

Yes, I want to register for Camp Gan Israel*

Camp Gan Israel

Session* Please select number of weeks attending camp

Name 2*

Child First Name Child Last Name

Hebrew & Nickname 2*

First Name Nickname

Gender 2*

MaleFemale

Birth Date 2*

Month Day Year

Yes, I want to register for Camp Gan Israel*

Camp Gan Israel

Session (Child 2)* Please select number of weeks attending camp

Name 3*

Child First Name Child Last Name

Hebrew & Nickname 3*

First Name Nickname

Gender 3*

MaleFemale

Birth Date 3*

Month Day Year

Yes, I want to register for Camp Gan Israel*

Camp Gan Israel

Session (Child 3)* Please select number of weeks attending camp

Name 4*

Child First Name Child Last Name

Hebrew & Nickname 4*

First Name Nickname

Gender 4*

MaleFemale

Birth Date 4*

Month Day Year

Yes, I want to register for Camp Gan Israel*

Camp Gan Israel

Session (Child 4)* Please select number of weeks attending camp

Address*

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

Home Phone Number*

Area Code Phone Number

E-mail*

Parent/Guardian Marital Status*

Parent 1 (or Guardian) Name*

First Name Last Name

Parent 1 Type*

Parent 1 Occupation*

Parent 1 Business Phone*

Area Code Phone Number

Parent 1 E-mail*

Parent 1 Cell Phone*

Area Code Phone Number

Parent 2 (or Guardian) Name*

First Name Last Name

Parent 2 Address*

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

Parent 2 Home Phone Number*

Area Code Phone Number

Parent 2 Type*

Parent 2 Occupation*

Parent 2 Business Phone*

Area Code Phone Number

Parent 2 E-mail*

Parent 2 Cell Phone*

Area Code Phone Number

Please describe your child's physical strengths and/or weakness (physical, emotional, intellectual):*

Father's Religion*

Mother's Religion*

Is child adopted*

NoYes

Synagogue Affiliation*

1. Child may be picked up from camp by:

Name and Relationship

2. Child may be picked up from camp by:

Name and Relationship

Emergency Contact Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Address*

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

Relationship*

Family Physician*

First Name Last Name

Phone Number*

Area Code Phone Number

Medical Insurance Company*

Insurance Group Number

Primary Insured Policy Number*

Child Policy Number*

Child 2 Policy Number*

Child 3 Policy Number*

Child 4 Policy Number*

MEDICAL RELEASE

I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Camp Gan Israel will undertake such decision.

COVID-19 AGREEMENT* We anticipate no specific health protocols will be in place.

I will follow the health & safety protocols regarding Covid-19 and affirm that I assume all risk and will not hold Chabad Lubavitch of Idaho or Camp Gan Israel or its staff, volunteers and attendees liable if exposed to Covid-19

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

My child/ren is permitted to be given Children's Tylenol, Motrin or similar:*

YesNo

Is your child/ren allergic to any medications?*

NoYes

Please specify medical allergies.

Is your child/ren allergic to any foods?*

NoYes

Please specify food allergies.

Is your child/ren up to date on all immunizations?*

YesNo

Does your child/ren have a medical, developmental or emotional condition that camp should be aware of?*

YesNo

Please specify condition(s).*

The purpose of securing background and developmental information about your child is to help our camp staff better understand your child. Your child’s care during the day is a responsibility we share.

Please complete the following questionnaire.

T-Shirt Size*

T-Shirt Size Child 2*

T-Shirt Size Child 3*

T-Shirt Size Child 4*

Has your child had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel BoiseNo

Has your child 2 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel BoiseNo

Has your child 3 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel BoiseNo

Has your child 4 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel BoiseNo

Please specify previous group experience(s) in which your child has participated.*

Please specify previous group experience(s) in which your child 2 has participated.*

Please specify previous group experience(s) in which your child 3 has participated.*

Please specify previous group experience(s) in which your child 4 has participated.*

Favorite Activity:

Child 2 Favorite Activity:

Child 3 Favorite Activity:

Child 4 Favorite Activity:

What are your child's particular strengths and talents?*

What are your child 2's particular strengths and talents?*

What are your child 3's particular strengths and talents?*

What are your child 4's particular strengths and talents?*

What other information is important to your child/ren's success?

TERMS AND CONDITIONS

PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Camp Gan Israel (CGI) both on and off site, trips, transportation to and from trips etc., unless I advise you otherwise in writing.

PAYMENT AND CANCELLATION: Payment terms are a $50.00 non-refundable registration fee per camper to accompany registration. The balance is due by July 1, 2024 and is non-refundable after that date.

In the event that camp is unable to open (due to COVID-19 regulations or similar) all fees, minus the registration fee, will be refunded.

DISMISSAL OF CAMPER: Parent fully understands and agrees that the Camp reserves the right to dismiss, in its sole discretion, any Camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of the Camp or fellow campers or who violates camp rules and regulations. In the event of dismissal, tuition will be refunded on a pro-rated basis less the registration fee.

IMAGES, ETC.: Permission is hereby given to use in promoting the Camp and in other ventures directly relating to the Camp (i) digital, photographic and video images or likenesses of camper; audio of camper; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by camper or originating from Camp or from a Camp-related activity.

INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad Lubavitch of Idaho, Chabad Jewish Center, Camp Gan Israel (CGI) and its officers, servants or assigns from any liability concerning our child’s involvement in CGI and further agree that the use of any premises during the CGI camp day is made at the risk of the registrant.

I have read and agree to all of the terms and conditions in this Application Form. I am including a non-refundable $50.00 registration fee per camper along with submission of this form. I further agree to remit the full tuition and any other fees by July 1, 2024.

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

Volunteering

I would like to volunteer during camp activities and trips.I would like to volunteer with transportation.I would like to volunteer in the camp kitchen.

Comments:

Your card will be charged a non-refundable $50 registration fee per camper. Upon acceptance to camp, you will be billed the full tuition amount and your registration fee will be applied.

Scholarship

I would like to apply for a scholarship. Please contact me.

Total

$0.00

Payment

Credit Card Paypal

Postal / Zip Code

Country

BOISE'S

Camp Gan Israel Registration

Registration Form

Camp Gan Israel Registration 2024

MEDICAL AND EMERGENCY CONTACT INFORMATION

BACKGROUND AND DEVELOPMENTAL INFORMATION

VOLUNTEERING

COMMENTS

PAYMENT