Registration - JewishBellaire.com

1. Child/ren’s Information
Number of Children Registering:*
Child 1:*

First Name Middle Name Last Name
Hebrew Name
Birth Date:*

Month Day Year
Gender:*

MaleFemale
School Attending:
Entering Grade:
What are your child’s favorite activities?
What kind of things would you like your child to experience at camp?
What do you consider your child’s most desirable traits?
Describe your child's likes/dislikes, emotional make-up and special concerns:
What works best to calm your child?
Describe your child's swimming ability:
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
T-shirt Size: ($18/shirt)*
Number of additional T-shirts

$18/ T-shirt
Division:*

Mini Gan: 3-5 Years OldMain Division: 6-12 Years Old
Mini Gan Registration:*

Full Session (full day): June 24 - July 19Full Session (half day): June 24 - July 19Week One (full day): June 24 - June 28Week One (half day): June 24 - June 28Week Two (full day): July 1 - July 5Week Two (half day): July 1 - July 5Week Three (full day): July 8 - July 12Week Three (half day): July 8 - July 12Week Four (full day): July 15 - July 19Week Four (half day): July 15 - July 19
Registration:*

Full Session: June 24 - July 19Week One: June 24 - June 28Week Two: July 1 - July 5Week Three: July 8 - July 12Week Four: July 15 - July 19
Early/After Care Early Care: $25/Week | After Care: $50 week

Week 1 Early CareWeek 1 After CareWeek 2 Early CareWeek 2 After CareWeek 3 Early CareWeek 3 After CareWeek 4 Early CareWeek 4 After Care
Child 2:*

First Name Middle Name Last Name
Hebrew Name:
Birth Date:*

Month Day Year
Gender:*

MaleFemale
School Attending:
Entering Grade:
What are your child’s favorite activities?
What kind of things would you like your child to experience at camp?
What do you consider your child’s most desirable traits?
Describe your child's likes/dislikes, emotional make-up and special concerns:
What works best to calm your child?
Describe your child's swimming ability:
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
T-shirt Size: ($18/shirt)*
Number of additional T-shirts:

$18/ T-shirt
Division:*

Mini Gan: 3-5 Years OldMain Division: 6-12 Years Old
Registration:*

Full Session: June 24 - July 19Week One: June 24 - June 28Week Two: July 1 - July 5Week Three: July 8 - July 12Week Four: July 15 - July 19
Mini Gan Registration:*

Full Session (full day): June 24 - July 19Full Session (half day): June 24 - July 19Week One (full day): June 24 - June 28Week One (half day): June 24 - June 28Week Two (full day): July 1 - July 5Week Two (half day): July 1 - July 5Week Three (full day): July 8 - July 12Week Three (half day): July 8 - July 12Week Four (full day): July 15 - July 19Week Four (half day): July 15 - July 19
Mini Gan Registration:

Full Session (full day): June 26 - July 21Full Session (half day): June 26 - July 21Week One (full day): June 26 - June 30Week One (half day): June 26 - June 30Week Two (full day): July 3 - July 7Week Two (half day): July 3 - July 7Week Three (full day): July 10 - July 14Week Three (half day): July 10 - July 14Week Four (full day): July 17 - July 21Week Four (half day): July 17 - July 21
Registration:

Full Session: June 26 - July 21Week One: June 26 - June 30Week Two: July 3 - July 7Week Three: July 10 - July 14Week Four: July 17 - July 21
Early/After Care: Early Care: $25 week | After Care: $50 week

Week 1 Early CareWeek 1 After CareWeek 2 Early CareWeek 2 After CareWeek 3 Early CareWeek 3 After CareWeek 4 Early CareWeek 4 After Care
Child 3:*

First Name Middle Name Last Name
Hebrew Name:
Birth Date:*

Month Day Year
Gender:

MaleFemale
Entering Grade:
School Attending:
What are your child’s favorite activities?
What kind of things would you like your child to experience at camp?
What do you consider your child’s most desirable traits?
Describe your child's likes/dislikes, emotional make-up and special concerns:
What works best to calm your child?
Describe your child's swimming ability:
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
T-shirt Size: ($18/shirt)*
Number of additional T-shirts:

$18/ T-shirt
Division:*

Mini Gan: 3-5 Years OldMain Division: 6-12 Years Old
Registration:*

Full Session: June 24 - July 19Week One: June 24 - June 28Week Two: July 1 - July 5Week Three: July 8 - July 12Week Four: July 15 - July 19
Mini Gan Registration:*

Full Session (full day): June 24 - July 19Full Session (half day): June 24 - July 19Week One (full day): June 24 - June 28Week One (half day): June 24 - June 28Week Two (full day): July 1 - July 5Week Two (half day): July 1 - July 5Week Three (full day): July 8 - July 12Week Three (half day): July 8 - July 12Week Four (full day): July 15 - July 19Week Four (half day): July 15 - July 19
Mini Gan Registration:

Full Session (full day): June 26 - July 21Full Session (half day): June 26 - July 21Week One (full day): June 26 - June 30Week One (half day): June 26 - June 30Week Two (full day): July 3 - July 7Week Two (half day): July 3 - July 7Week Three (full day): July 10 - July 14Week Three (half day): July 10 - July 14Week Four (full day): July 17 - July 21Week Four (half day): July 17 - July 21
Registration:

Full Session: June 26 - July 21Week One: June 26 - June 30Week Two: July 3 - July 7Week Three: July 10 - July 14Week Four: July 17 - July 21
Early/After Care: Early Care: $25 week | After Care: $50 week

Week 1 Early CareWeek 1 After CareWeek 2 Early CareWeek 2 After CareWeek 3 Early CareWeek 3 After CareWeek 4 Early CareWeek 4 After Care
Child 4:*

First Name Middle Name Last Name
Hebrew Name:
Birth Date:*

Month Day Year
Gender:

MaleFemale
Entering Grade:
School Attending:
What are your child’s favorite activities?
What kind of things would you like your child to experience at camp?
What do you consider your child’s most desirable traits?
Describe your child's likes/dislikes, emotional make-up and special concerns:
What works best to calm your child?
Describe your child's swimming ability:
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
T-shirt Size: ($18/shirt)*
Number of additional T-shirts:

$18/ T-shirt
Division:*

Mini Gan: 3-5 Years OldMain Division: 6-12 Years Old
Mini Gan Registration:*

Full Session (full day): June 24 - July 19Full Session (half day): June 24 - July 19Week One (full day): June 24 - June 28Week One (half day): June 24 - June 28Week Two (full day): July 1 - July 5Week Two (half day): July 1 - July 5Week Three (full day): July 8 - July 12Week Three (half day): July 8 - July 12Week Four (full day): July 15 - July 19Week Four (half day): July 15 - July 19
Registration:*

Full Session: June 24 - July 19Week One: June 24 - June 28Week Two: July 1 - July 5Week Three: July 8 - July 12Week Four: July 15 - July 19
Mini Gan Registration:

Full Session (full day): June 26 - July 21Full Session (half day): June 26 - July 21Week One (full day): June 26 - June 30Week One (half day): June 26 - June 30Week Two (full day): July 3 - July 7Week Two (half day): July 3 - July 7Week Three (full day): July 10 - July 14Week Three (half day): July 10 - July 14Week Four (full day): July 17 - July 21Week Four (half day): July 17 - July 21
Registration:

Full Session: June 26 - July 21Week One: June 26 - June 30Week Two: July 3 - July 7Week Three: July 3 - July 7Week Four: July 17 - July 21
Early Care/After Care: Early Care: $25 week | After Care: $50 week

Week 1 Early CareWeek 1 After CareWeek 2 Early CareWeek 2 After CareWeek 3 Early CareWeek 3 After CareWeek 4 Early CareWeek 4 After Care
2. Parent information

Address:*

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

Home Phone Number:*

Area Code Phone Number
Fathers Name:*

First Name Last Name
Father's Occupation:*
Father's Work Phone*

Area Code Phone Number
Father's Cell Phone*

Area Code Phone Number
Father's E-mail:*
Mother's Name:*

First Name Last Name
Mother's Occupation:*
Mother's Work Phone*

Area Code Phone Number
Mothers Cell Phone:*

Area Code Phone Number
Mothers E-mail:* Primary email
How did you hear of us?
3. Emergency Information
Emergency Contact:*

First Name Last Name
Phone Number:*

Area Code Phone Number
Relationship:*
Pediatrician:

First Name Last Name
Phone Number:

Area Code Phone Number
Insurance:
Policy #:
4. Consent
TERMS & CONDITIONS

PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Camp Gan Israel both on and off site, including trips, transportation to and from trips etc., unless I advise you otherwise in writing. PAYMENT AND CANCELLATION: Payment terms are: $150 deposit ($75 non refundable registration fee + $75 applied to tuition). Full tuition (Minus any scholarship) is due by June 1st, and is non-refundable after that date. DISMISSAL OF CAMPER: I fully understand and agree that Camp Gan Israel 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 his/her fellow campers or who violates camp rules and regulations. MEDICAL CARE: In case of emergency, I hereby give permission to the physician selected by the camp director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an MD. Every effort will be made to contact the Parent / Legal Guardian and emergency contacts first. Should it be necessary for the wellbeing of the camper to utilize outside medical or dental services, all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify the camp if he/she is exposed to any infectious diseases. I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the Director’s decision. 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 Camp Gan Israel (CGI) and its officers, servants or assigns from any liability or claim for any loss, injury, damage or expense resulting or arising from my child’s participation in camp activities. I further agree that the use of any premises during the CGI camp day is made at the risk of the registrant.

In addition, I acknowledge that the camp administration reserves the right to reconsider the enrollment of any camper if we feel the child’s needs or level of functioning or behavior cannot be accommodated, or if the child’s conduct limits his or her ability to participate in, or to benefit fully from, the program and activities at Camp Gan Israel. In addition, I acknowledge that I have read and accept the financial obligations and the refund policy as stated in the application form.
I Accept*

YesNo
Full Name*

First Name Last Name
Date*

Month Day Year
5. Payment Information

$150 registration fee per camper (includes a $75 non-refundable registration fee, with the remaining $75 to be applied toward camp tuition.)
(2.5% processing fee will apply for all CC transactions)
Total Due:

$0.00

I would like to pay today:Full amount$150.00 minimum$

Payment:

Credit Card Check/Zelle

Please charge my balance:*

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1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Consent

5. Payment Information