REGISTRATION
Camp Gan Israel Extreme - Summer 2017

Please fill out ALL fields of this form. If you would like to register more than two children, please fill out the form again.

If you have any questions or concerns you'd like to discuss with us feel free to contact our director, Chana, at 845-662-6604 or [email protected].

Camper 1 Profile     Camper 2 Profile
First Name
    First Name
Last Name
    Last Name
Hebrew Name (Optional)
     Hebrew Name (Optional)
Age
    Age
DOB
    DOB
T-Shirt Size
    

T-Shirt Size
Does your child have any
learning or behavioral
challenges? Please specify

This information will help us better cater to the
needs of your child.		     Does your child have any
learning or behavioral
challenges? Please specify 

This information will help us better cater to the needs
of your child.
Family Information
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Parent Information
Father's Name Father's Cell Mother's Name
Mother's Cell
Home Phone
Address
City
Zip
Email*
What are some of the goals you hope your child will achieve through attending the camp?  
* Email allows us to communicate in the most efficient and economical manner.
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
Persons Authorized to Pickup Child/ren
 
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Tuition Agreement

The fee for camp must be paid two weeks before camp begins.

Scholarships
We believe that every Jewish child should experience the joys of a Jewish summer camp. A limited number of scholarships are available upon request. Call our office at 845-782-2770 to request scholarship.

Discounts

  • $30 Referral discounts – If you refer a new camper to Camp Gan Israel and they register for the full week, you will receive $30 off.  A "new" family qualifies as a child who is Jewish has not yet attended Camp Gan Israel or Chabad Hebrew School. This offer is unlimited (Refer 6 new campers and come free!). 

Camp Fees:

  • Full Week: $180 plus $10 Camp t-shirt
  • Per day: $40 

Payment Plans:

Please Note: We plan for each camper who enrolls.  Chabad does not refund payment for days missed.

Payment Information
Payment Method   Checks can be mailed to Chabad • 1170 Route 17m, Suite 1, Chester, NY 10918
Card Type   Card Number
Expiration   CVV (code)
Additional Comments (optional):

 

IMPORTANT:  Please also print and mail in HEALTH FORM 
Mail to:  Chabad of Orange County, 1170 Route 17m Suite 1, Chester, NY 10918


We look forward to a wonderful summer of creativity, learning and fun!