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Ben & Diane Docktor – Camp Gan Israel 2017-5777 Hosts
in memory of Aron and Ida Eichler z'l

 

Camp Gan Israel Registration Form


(For Teen Camp Click here)

One form per child please.
For families with multiple children, you can download the PDF found here
and fax, email, or come drop-off the completed form in-person.

Camper Information

Camper Name
First name:

Last name:

Camper Hebrew Name

Gender
Male Female

Date of Birth

School Attending

Grade Completed

Address Information

  • Address
  • City
    Province
    Postal Code
    Home Phone:
  •  

  • Parent's Information

    First Name:

  • Last Name:

Father's Work Number

  •  
  • First name:

    Last name:
  •  

     

  • Mother's Work Number
  •  
  •  

Medical Information

First name:

Last name:

 

 

Physician's Phone Number:

Alberta Health Care Number:

Allergies

Medical Notes

Emergency Contact
First name:

Last name:


Relation to Camper:

Emergency Contact Phone Number:


Enrollment Options

Please select program & weeks of enrollment

Kiddie Camp:
Age 3: Half-Day 9:00AM to Noon

Age 4: Half-Day 9:00AM to Noon
Age 4: Full-Day 9:00AM to 3:30PM

Day Camp:
Ages 5 -12: 9:00AM to 3:30PM

All Five Weeks
July 3 - July 7
July 10 - July 14 
July 17 - July 21
July 24 - July 28 
 July 31 - August 4


Extended Care Options

AM Option: 8:00AM-9:00AM
Please specify weeks required
AM Ext Care Week 1
AM Ext Care Week 2
AM Ext Care Week 3
AM Ext Care Week 4
AM Ext Care Week 5

PM Option 3:30PM-5:00PM
Please specify weeks required
PM Ext Care Week 1
PM Ext Care Week 2
PM Ext Care Week 3
PM Ext Care Week 4
PM Ext Care Week 5

Do you have a camp t-shirt? Yes No

If you do not have a camp t-shirt, which is mandatory for field trips and outings, please select the size below. The cost for a t-shirt is $13.00.

Camp Rates

Rates per week

$118-- Half Day (Ages 3 - 4) *
• $228 -- Full Day (Kindergarten to Grade 3) *
• $246 -- Full Day (Grade 4 and up)
*


Rates above are early bird rates.
Early bird rates are valid through April 30, 2017.
After April 30, please add $15 per week.

* Daily Lunches & Snacks provided at NO extra cost. *
Extended Care Rates
AM Only $18 per week PM Only $28 per week AM & PM $39 per week

Payment Information

Sub total: $  * Did you adjust for post-Early Bird pricing?

T-shirt purchase: $

Sibling Discount: $
(5% off for each additional sibling. Excludes T-shirt and Extended Care options.)

GRAND TOTAL: $

Payment Method:

Card Type: Visa MasterCard American Express

Cardholder's Name:

Card Number:

Expiration Date: /

Consent

I/we have read the camp brochure, application form, and 'Dates and Rates' and agree to the terms stated. I/we give my/our child permission to attend all trips, and receive medical care in the case of emergency.
I/we permit the use of pictures and videos that may have my/our child in them for Camp Gan Israel's website and future Chabad publications.

Date of Application:


Name of Applicant:

Comments:

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Camp Gan Israel 134 Forge Road SE Calgary, AB T2H 0S8 Canada 403-238-4880 Ext. 110
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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