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Summer Camp Registration

Limited availability, first come first serve basis.

Dates:

Monday, June 1 - Friday, June 19, 2026
9:00 am - 3:00 pm

Optional Extended Care
After Care: Monday - Thursday 3:00 - 5:00 pm- $25 per week

PLEASE NOTE: THERE IS NO AFTER CARE ON FRIDAY AFTERNOON.

Division	Weekly Rate	Full Summer (3 Weeks)
Explorers (Grades K–1)*	$225 (Early Bird: $200)	$675 (Early Bird: $600)
Trailblazers (Grades 2–4)	$225 (Early Bird: $200)	$675 (Early Bird: $600)
Pioneers (Grades 5–7)	$275 (Early Bird: $250)	$825 (Early Bird: $750

*Limited Availability for Explorers: Grades K - 1. Contact Chanie for more information.

LIMITED SCHOLARSHIPS ARE AVAILABLE UPON REQUEST . For those requesting a scholarship, please complete this form. For more information, please email [email protected]
Early bird pricing ends March 31st.

Family Information:
Family Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
Father's E-mail*
Mother's E-mail*
Mother's Name*
First Name Last Name
Mother's Hebrew Name*
Mother's Work Phone Number*
Mother's Cell Phone Number*
Father's Name*
First Name Last Name
Father's Hebrew Name*
Father's Work Phone Number*
Father's Cell Phone Number*
Emergency Contact Person One:*
First Name Last Name
Emergency Contact One: Phone Number*
Relationship*
Emergency Contact Person Two:*
First Name Last Name
Emergency Contact Two: Phone Number*
Relationship*
Pediatrician Name*
First Name Last Name
Pediatrician Phone Number*
Insurance Policy Number
Group Number
Who can we thank for referring you?
Number of children being registered:*
Camper One Information
Name*
Gender*

MaleFemale
Date of Birth*

Month Day Year
School*
Entering Grade:*
Medication*
Allergies*
Health Issues, Disabilities, or Special Needs of child:*
I would like to order the following amount of tshirts*
$12 each
T-shirt size (New Color This Summer)
(A) implies Adult Sizes
Age Group*

Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7
Explorers/Trailblazers attending:

Full SessionWeek 1Week 2Week 3
Pioneers attending:

Full SessionWeek 1Week 2Week 3
I will need the following amount of weeks of after care ($25/week)
Camper Two Information
Name
Gender

MaleFemale
Date of Birth

Month Day Year
School
Entering Grade:
Medication
Allergies
Health Issues, Disabilities, or Special Needs of child:
I would like to order the following amount of tshirts
$12 each
T-shirt size (New Color This Summer)
(A) implies Adult Sizes
Age Group

Explorers: Grades K - 1Trailblazers: Grades 2 - 4Pioneers: Grades 5 – 7
Explorers/Trailblazers attending:

Full SessionWeek 1Week 2Week 3
Pioneers attending:

Full SessionWeek 1Week 2Week 3
I will need the following amount of weeks of after care ($25/week)
IMPORTANT
All forms must be completed and submitted before your child begins camp.
Click here to access the scholarship form.
Agreement:*

I authorize Camp Gan Israel to charge my card the full tuition amount once accepted.
Camp Security:
We have employed full time security during camp hours. Please consider a donation to the security fund to help cover the large increase in our budget:

$180$360$540$1000
Questions/Comments:
Total

$0.00

Payment*

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Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I have read and agree to the terms and conditions. I authorize Camp Gan Israel 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.
Please type your name here:*
Date of Application:*
I would like to receive news and updates by email
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Family Information:

Camper One Information

Camper Two Information

IMPORTANT

Camp Security: