CIT Registration Part 2 Summer Day Camp 2024

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After submitting CIT registration part 1, please submit this form before May 15th
CIT Information
CIT'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:
Transportation (Additional Fee)
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, $85 a week - Door to Door
Please select which weeks you will need bus transportation - $40 a week.

Week 1 June 24 - June 28Week 2 July 1 - July 5Week 3 July 8 -July 12Week 4 July 15 - July 19Week 5 July 22 - July 26
Door to Door Transportation - $85 a week. Please indicate which weeks you will need bus transportation

Week 1 June 24 - June 28Week 2 July 1 - July 5Week 3 July 8 -July 12Week 4 July 15 - July 19Week 5 July 22 - July 26
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?*
Select The Size
Optional Camp Gan Izzy SWIM SHIRTS

The cost for each swim shirt is $23
How Many Swim Shirts Would You Like To Purchase?*
Select The Size
Total

$0.00
Click here to download your child's health form. Please click here to upload your health form.
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 upload my health form before the start of camp.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 Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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CIT Information

Emergency Contact Information.

Child Health Information

Transportation (Additional Fee)

T-shirts - $12 each

Optional Camp Gan Izzy SWIM SHIRTS

Parental Consent