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Please complete this form in its entirety.

Camper’s Last Name


	Date of Birth

	Camper’s First Name


	Hebrew Birthday

	Camper’s Hebrew Name


	Entering Grade

	Street Address


Zip Code

	City


	Home Phone

	State


	Email Address

Name of School


School Address


	Principal


School Phone

Father’s Occupation


	Mother’s Occupation


Father’s Business Address


Mother’s Business Address


Father’s Cell Phone


Mother’s Cell Phone


	Father’s Email


	Mother’s Email


	Phone


	Phone

Married Status


	With whom does camper reside

Alternative emergency contact name



Relation to Camper


	Day Phone


	Evening Phone

*2008 Schedule, Fees and Policies*

Please enroll my son in the following session(s):


	Session 1 (Tuesday, July 8 – Monday, July 28) $2,600


	Session 2 (Monday, July 28 – Monday, August, 18) $2,600

	Sessions 1 & 2 (Tuesday, July 8 – Monday, August, 18) $5,000

	The camp fee does not include transportation by bus to and from camp, which is billed separately for those who use the service.



		© 2007 Camp Gan Israel Florida. All Rights Reserved. A division of Chabad of North Broward & South Palm Beach