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Camp Gan Israel

Winter Camp!

Winter Camp Registration Form
Child 1 Information
Full Name

First Name Last Name
Birth Date

Month Day Year
School
Grade
Allergies
Medicare Number and Expiry Date
Child 2 Information
Full Name

First Name Last Name
Birth Date

Month Day Year
School
Grade
Allergies
Medicare Number and Expiry Date
Parent 1 Information
Relationship to Child
Full Name

First Name Last Name
E-mail
Cell Number

Area Code Phone Number
Home Number

Area Code Phone Number
Work Number

Area Code Phone Number

Address

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

Parent 2 Information
Relationship to Child
Full Name

First Name Last Name
E-mail
Phone Number

Area Code Phone Number

Address if Different

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

Emergency Contact
Full Name

First Name Last Name
Phone Number

Area Code Phone Number
Registration & Payment
Price per day: $45/day

Please select the days you want to register your child:
Child 1:

Monday, Dec 27, 2021 Tuesday, Dec 28, 2021 Wednesday, Dec 29, 2021 Thursday, Dec 30, 2021
Child 2:

Monday, Dec 27, 2021 Tuesday, Dec 28, 2021 Wednesday, Dec 29, 2021 Thursday, 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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