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Camp Gan Israel

Winter Camp!

Winter Camp Registration Form
Child 1 Information
Full Name
First NameLast Name
Birth Date
MonthDayYear
School
Grade
Allergies
Medicare Number and Expiry Date
Child 2 Information
Full Name
First NameLast Name
Birth Date
MonthDayYear
School
Grade
Allergies
Medicare Number and Expiry Date
Parent 1 Information
Relationship to Child
Full Name
First NameLast Name
E-mail
Cell Number
Area CodePhone Number
Home Number
Area CodePhone Number
Work Number
Area CodePhone Number

Address

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

Parent 2 Information
Relationship to Child
Full Name
First NameLast Name
E-mail
Phone Number
Area CodePhone Number

Address if Different

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

Emergency Contact
Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Registration & Payment
Price per day: $45/day
Please select the days you want to register your child:
Child 1:
Monday, Dec 27, 2021Tuesday, Dec 28, 2021Wednesday, Dec 29, 2021Thursday, Dec 30, 2021
Child 2:
Monday, Dec 27, 2021Tuesday, Dec 28, 2021Wednesday, Dec 29, 2021Thursday, Dec 30, 2021
$50 CAD$75 CAD$100 CAD
Total
$0.00 CAD

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Should be Empty:

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