REGISTRATION PART 1 SUMMER DAY CAMP - ........................................................................................

CIT Gan Izzy Day Camp Registration - Part One
To secure a spot for your child, a $60 non-refundable registration fee is required.
Parent Information
Please fill out all parent information. If Parent is a single parent please enter NA.
Mother's Name*

First Name Last Name
Mother's Cell Phone Number*

Area Code Phone Number
Mother's Work Phone Number

Area Code Phone Number
Mother's Email*
Father's Name*

First Name Last Name
Father's Cell Phone Number*

Area Code Phone Number
Father's Work Phone Number

Area Code Phone Number
Father's Email*
Are the natural parents of the child Jewish?*

Both ParentsMother OnlyFather Only
CIT's information
CIT's Full Name*

First Name Last Name
CIT's Jewish Name

CIT's Address*

CIT's Cell Phone Number*

Area Code Phone Number
CIT's Age* Girls finishing 7th & 8th grade
CIT's Birth Date*

Month Day Year
Grade *
School Attending *
Hebrew School Attending (if Any)
Sessions Attending
Please select sessions attending*
Please select the weeks your child will be attending

Week 1 June 26 - June 30Week 2 July 3 - July 7Week 3 July 10 -July 14Week 4 July 17 - July 21Week 5 July 24 - July 28
Payment
Please choose how you would like to pay*

Charge my credit card in full now
Total includes camp tuition and the $60 registration fee.
Total

$0.00
1) Please note the credit credit will be charged manually so it might take a couple of days to see the charge on your credit card.

2) Part 2 registration
Please fill out part 2 registration at www.ganizzy.info/register2 before May 15th.
When filling out part 2 registration you will have the option to add T-shirts, Transportation, PreCare or Aftercare. If you choose any of the above options, you will be charged separately for these fees when submitting the part 2 registration.

Payment*

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

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CIT Gan Izzy Day Camp Registration - Part One