Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
  First                       M
Last                                  Hebrew Name             
Address
  Street
City State                    Zip              
Date of Birth
   AM PM    
School Info
  Current School  Grade

Hebrew School  Yes No

Family History
 

Adoption                      

Father's Judaism Mother's Judaism     
Child's Mother
  Mother's Name
Email 

Work Phone

Cell Phone   

Child's Father
  Father's Name
Email

Work Phone

Cell Phone   

Emergency Contact Info
  Name
Phone      Relationship  
Pediatrician
  Name
Phone       Email   

Insurance Information

  Insurance Provider   Policy Number   
 Allergies/ Medications    List any Allergies  List Any Medications Other Medical Issues?   
Please contact me regarding:   Scholarship      Extended Care
Please indicate number of sessions your child will attend camp:
 
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Check Mastercard Visa
        
In the event that neither parent nor the emergency contact can be reached, Camp Gan Israel has my permission to render any necessary first aid or to secure care by a physician while attending camp. 
               I give my child permission to be taken on all field trips sponsored by Chabad of Southern Nevada and Camp Gan Israel.
              Although Camp Gan Israel carries Limited Liability Insurance protecting the camp premises against physical damage and covering the staff against negligence. Nevertheless, I accept complete responsibility for damages caused by child and for injuries incurred, and I agree to hold Chabad of Southern Nevada and Camp Gan Israel and its staff harmless, and I hereby release said parties from all liability except in cases of gross negligence. 
  Date of Application: