Gan Izzy Day Camp Registration - Part Two A day camp for Jewish children, celebrating our traditions. 1) After submitting part 1 registration for your child for camp, please submit this form before May 15th. 2) This form is per a camper. If you have more than one child participating in Gan Izzy this summer, you will need to complete this form per child. 3) Please email your child's medical form, before June 1st to [email protected] Click here to download the health form Camper Information Camper's Name* First Name Last Name Parent email address* Emergency Contact Information.When parent is not available Emergency Contact Name* First Name Last Name Relationship To Child* Emergency contact Phone Number* Area Code Phone Number Child Health Information Pediatrician Name* First Name Last Name Pediatrician Phone Number* Area Code Phone Number Does your child have allergies?* YesNo If yes, please specify what your child is allergic to, and any medications: Is your child under medical care, have any current health problems, or taking any medication?* YesNo If yes, please explain Friend Request (optional) Is there a friend your child would like to be in the same bunk with?* YesNo While we make every effort to accommodate each camper’s request, we can’t guarantee that your child will be with the friend they have chosen. Friend request Friend 1 Friend 2 Pre/After Care Precare from 8am - $6 per day when paid in advance per week. Pay as you go, daily $7 Aftercare until 4:30pm -$6 per day when paid in advance per week. Pay as you go, daily $7 until 5:30pm - $12 per day when paid in advance per week. Pay as you go, daily $14 Would you like Pre-Care for your child* NoYes, pay in advance per week - $6 per dayYes, pay as you go - $7 per day Please select the weeks to prepay for Precare Week 1 June 23 - June 27Week 2 June 30 - July 3Week 3 July 7 -July 11Week 4 July 14 - July 18Week 5 July 21 - July 25 Would you like After-Care for your child* NoYes, pay in advance for aftercare. Until 4:30pm - $6 or until 5:30pm - $12 per dayYes, pay as you go until 4:30pm - $7 a dayYes, pay as you go until 5:30pm - $14 a day Please select until what time and which weeks you would like to prepay for Aftercare 4:30pm - Week 1 June 23 - June 274:30pm - Week 2 June 30 - July 34:30pm - Week 3 July 7 - July 114:30pm - Week 4 July 14 - July 184:30pm - Week 5 July 21 - July 255:30pm - Week 1 June 23 - June 275:30pm - Week 2 June 30 - July 35:30pm - Week 3 July 7 - July 115:30pm - Week 4 July 14 - July 185:30pm - Week 5 July 21 - July 25 Transportation (Additional Fee) Door to door transportation is full from certain areas. Please contact the camp office before choosing the door to door option to see if there is available space on the route in your area. Transportation provided from most locations, for an additional fee. Please call 215 497 9925 Ext. 3 or email [email protected] to see if we offer busing from your area. General Pick Up is $40 a week Before May 15th - Door to door option $70 a week for the first child, $40 per an additional child. After May 15th- Door to door option $85 a week for the first child, $40 per an additional child. Would you like bus transportation for your child? NoYes, $40 a week - General Pickup or second child door to doorYes, $70 a week - Door to Door Please select which weeks you will need bus transportation - $40 a week. Week 1 June 23 - June 27Week 2 June 30 - July 3Week 3 July 7 -July 11Week 4 July 14 - July 18Week 5 July 21 - July 25 Door to Door Transportation - $70 a week. Please indicate which weeks you will need bus transportation Week 1 June 23 - June 27Week 2 June 30 - July 3Week 3 July 7 -July 11Week 4 July 14 - July 18Week 5 July 21 - July 25 T-shirts - $12 each It is mandatory to wear a camp T-shirt on trip days. Therefore, we recommend a minimum of 2 T-shirts. The cost for each T-shirt is $12 How Many T-shirts Would You Like To Purchase?* None I have enough from last year123456 Select the camp T-shirt size Child Extra Small (2-4)Child Small (4-6)Child Medium (8-10)Child Large (10-12)Child Extra Large (12-14)Adult Small Adult MediumAdult LargeAdult Extra Large Optional camp Gan Izzy SWIM SHIRTS The cost for each swim shirt is $24 How Many Swim Shirts Would You Like To Purchase? 0123 Select the swim shirt size Child Extra Small (2-4)Child Small (4-6)Child Medium (8-10)Child Large (10-12)Child Extra Large (12-14)Adult Small Adult MediumAdult LargeAdult Extra Large Total $0.00 In order to create an effective and positive camp environment for everyone, please provide the information about your child. All information will be handled with care and held in confidence: Does your child have an IEP or 504 Plan?* YesNo Please email your child's IEP or 504 to [email protected] Please select any of the items that apply to your child Has a short attention spanIs overly activeIs very sensitive/upsets easilyHas social challengesHas emotional challengesHas medical challengesHas special needs/disabilitiesHas a learning disability Please share more information about specific challenges here Please share any information that may affect performance or behavior while in camp Please share any tools and strategies that benefit your child in your home or school that we might incorporate into the camp environment How did you hear about Gan Izzy? Returning CamperFriend or Family MemberEmailSocial Media Click here to download your child's health form. Please email your child's health form before June 1st to [email protected] Parental Consent Parental Consent* I permit my child to participate in all activities of Gan Izzy Day Camp - on site, off site and trips.I give permission for Gan Izzy Day Camp to photograph my child and use the photos in brochures, and for all promotional purposes.I will email my child/rens health form by June 1st, to [email protected]I understand that my child may be dismissed due to illness, at the discretion of the camp, and I agree to abide by the director's decision.The parent who signs this registration form represents that he/she has full authority to do so, and will be responsible for payment of the camp fees. Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.