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Please fill out a separate registration form for each child!

Camper/Parent Information
Child's Name
  First
Last
   
Address
  Street
City
State
Zip

Birthdate
  (mm/dd/yyyy) 
   
Contact Info
  Home Phone
Email (for important info)  
School
  School
Hebrew School Current Grade 
Child's Mother
  Mother's First & Last Name
Mother's Hebrew Name Work Phone Cell
Child's Father
  Father's First & Last Name
Father's Hebrew Name Work Phone Cell
Emergency Contact Info
  Emergency Name
Emergency Phone Relationship  
Pediatrician
  Pediatrician Name
Pediatrician Phone    

Additional Email

 


   
Camper's T-Shirt Size (for summer only)

 

Youth Extra-Small
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Extra-Large

   
           

Medical Information

Does your child have any allergic reactions to food or medication? Please list:

Is your child currently on medication? Please list here:

Please list any other medical conditions or special circumstances that we should know about here:

 

*Family Information

*We ask these questions in order to better understand and relate to each child!


Any conversions or adoptions in the family?
Yes No

 

If yes, please explain:


Marital status of parents:


Did another family refer you to Gan Israel? List their name here (if applicable):

 

Payment & Release Forms

   
 
Payment in full is due at the time of registration.

* Early-bird (registering by Dec. 4th): $199

* After Dec. 4th: $220

 

 

I will be paying via:
Mastercard
Visa
AmEx
Discover

 


Card number: Exp:
Billing Address (Street, City, Zip):  
Security Code:

As the parent or legal guardian of the above child, I hereby release Chabad of Lakeview from any and all liability arising from claims for injuries or damages that either individually or on behalf of my child might occur during participation in Camp Gan Israel activities. I authorize any adult acting on behalf of Chabad of Lakeview's Camp Gan Israel to treat, hospitalize, or secure treatment for my child. 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 personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all camp activities and field trips. I understand that my child may be photographed while participating in Camp Gan Israel activities and that these pictures may be used for marketing purposes. By checking the box to the left and entering my name below, I accept these terms and conditions.

 
Signature (please enter first and last name):
  Date of Signature:

Thank you for choosing CGI of Lakeview! We look forward to an AMAZING camp experience!

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Chabad of Lakeview ~ JewishLakeview.com ~ 655 W. Irving Park Rd., Ste. 207
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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