Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

 

Camper / Parent Information

Camper’s Name

 

First

Middle

Last

Hebrew Name

Address

 

Street

City

State

Zip

Date of Birth

 

 

 

 

 

School

  

School

Entering Grade:

Contact Info

  

Phone

Email

Child’s Mother

 

Mother’s Name

Hebrew Name

Work Phone

Cell  

Child’s Father

 

Father’s Name

Hebrew Name

Work Phone

Cell

Other Questiond:

 

Does your child have friends attending?

Activities your child should not participate?

Emergency Contact Info

 

Name

Phone

Relationship

 

Emergency Contact Info

 

Name

Phone

Relationship

 

Pediatrician:

 

Name:

Phone:

Health Notes:

 

Does child have any health problems or disabilities?  Other?

Health Notes:

 

Medication?

Allergies?


 

Other Information:  Price per week is $150

Child’s Age Group:

 

  Ages 3-4

  Ages 5-12

Weeks Attending:

 

Week1:

Week2:

Week3:

Other:  

Camp T-Shirt:

 

Small:

Medium:

Large:

X-Large:


 

Important

 

 

Permission:  I authorize Camp Gan Israel of Spokane, to have my child treated in case of emergency by a physician in the manner such person deems necessary.  I further give permission for my child to attend and be transported on camp trips.

 

 

Date of Application: