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Camp Gan Israel
fun forever!

Registration

Registration

Download a Parents' Handbook

Please fill out the form below.

Registration Information
Camper 1
  First Name
Last Name
Age
Grade
Attending
 

1st Week

2nd Week        3rd Week

   
Camper 2
 

First Name

Last Name
Age
Grade
Attending
 

1st Week

2nd Week         3rd Week  
Camper 3   First Name
Last Name
Age
Grade
Attending   1st Week 2nd Week     3rd Week    
Legal Guardian   First Name

Last Name


 
Mailing
Address

  Street
City
State
Zip
    Phone
Email    
Emergency
Contact #1
  Name
Phone
   
Emergency Contact #2   Name
Phone
   
Allergy Info:   Please provide any allergy or other medical information we should be know about:
 

Deposit Payment Method: Credit Card Check

Camp Fees:

Ages 4-12

One Week: $219 - Register By June 21 $199
Both Weeks: $419 - Register by June 21 $379
Three Weeks: $599 - Register by June 21 $519 

Discounts: Sibling Children additional 5% discount

To register by mail and to mail checks:
Please print this form and mail it with your payment to:
Chabad Jewish Community Center
3579 Arlington Ave., Suite 100
Riverside, CA 92506
Payment Options:

1. One payment in the amount of to be paid on .

2. Two payments in the amount of to be paid on and to be paid on

Visa Mastercard Discover Amex

Card Holder's Name:
CC Number:
Expiration Date:  Security Code:  

Total Payment:

Releases:

As the parent(s) or legal guardian of the above child/ren, I authorize any adult acting on behalf of Camp Gan Israel/Chabad of Riverside to transport my child/ren by means of transportation provided. My child/ren is allowed to participate in all off campus activities and trips. In the event of an emergency, when I am not available, I authorize a representative of Cam Gan Israel/ Chabad of Riverside to make such arrangements as considered necessary, to receive medical or hospital care. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit Camp Gan Israel/Chabad of Riverside personnel will try, but are not required, to communicate with me/us prior to such treatment.

I agree to the terms and conditions above.

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