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Please fill out a separate registration form for each child!

Camper/Parent Information
Child's Name

Contact Info
  Home Phone
Email (for important info)  
Hebrew School Grade Entering 
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 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 religious 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

You may choose "pay in full now" or "payment plan."  For payment plans, a non-refundable $100 deposit per child will be charged now, and your remaining balance due will be charged in equal increments each 1st of the month through June 1st.  If registering after June 1st (space permitting), payment in full will be charged immediately. 

A 10% discount will be taken off the below prices for each sibling registered.


 Pay in Full Now
 Payment Plan  


Entire Summer:  $1350 Early-Bird // $1500 after Feb. 16th

Entire Summer (June 25th thru August 3rd)


2-Week Session(s):  $495 Early-Bird // $550 after Feb. 16th
 Session 1 (June 25th thru July 6th)
 Session 2 (July 9th thru July 20th)
 Session 3 (July 23rd thru August 3rd)


Individual Week(s):  $275 Early-Bird // $295 after Feb. 16th
 Week 1 (June 25th-29th)
 Week 2 (July 2nd-6th)
 Week 3 (July 9th-13th)
 Week 4 (July 16th-20th)
 Week 5 (July 23rd-27th)
 Week 6 (July 30th-August 3rd)

(you will not be charged immediately; we will contact you to finalize your early & aftercare arrangements):
 I am interested in EARLYCARE ($20 per morning)
 I am interested in AFTERCARE ($25 per afternoon)



I will be paying via:


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 ~ ~ 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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