Register Online! | Camp Gan Israel of Rochester NY

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	General Information
	Register Online!
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	Mission Statement
	Counselor Application
	Junior Counselor Application

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2010 Online Registration!

Please fill out the form below carefully. There is a $50.00 per family registration fee that will be applied toward the tuition, if the registration form is received before June 1. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child. If you would like to register more then one child, hit the back button after you submit the form and change the necessary information.

Camper/Parent Information
Name		First	Hebrew Name	Last	Male Female
Address		Street	City	State	Zip
Date of Birth					Age :
Contact Info		Home Phone	Father Email	Mother Email
Schools		School	Current Grade:
Child's Mother		Mother's Name	Hebrew Name	Work Phone	Cell
Child's Father		Father's Name	Hebrew Name	Work Phone	Cell
Emergency Contact Info		Name	Phone	Relationship
Pediatrician		Name	Phone
Referred By

Select Child's Program
	Primary Camp			Mini Gan Izzy
	Mini Mini Gan Izzy			Mini GI Exdended
	Girls Pioneer
Please indicate which weeks your child will attend camp:
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7
		Click for camp dates
IMPORTANT
•	All forms must be completed and submitted before your child begins camp.

	I hereby register my child in Camp Gan Israel and give permission for my child to participate in all camp activities, including trips. I understand that camp does not assume responsibility for any injury, and in case of emergency, necessary medical attention may be secured by the camp. A medical form will be sent to you after registration. After you submit this form you will have the opportunity to pay the $50.00 registration fee at www.chabadrochester.com/donate.

	Date of Application:

Camp Gan Israel of Rochester NY • 1037 Winton Road South • Rochester, NY 14618 • 585-271-0330
A branch of the world's largest Jewish Camping network, Camp Gan Israel International