Winter Day Camp Registration - ....................................................... - Camp Gan Izzy - Jewish Day Camp - Bucks County

Address*

Gender*

FemaleMale
Grade*
Age* Girls ages 5 - 13 Boys ages 5 - 11
School*
Hebrew School (if applicable)
Parent's Information
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's Email*
Father's Name
First Name Last Name
Father's cell

Area Code Phone Number
Father's Email
Emergency Contact and Medical Information
Emergency Contact*
First Name Last Name
Relationship to child*
Phone Number*

Area Code Phone Number
If your child has any allergies or medical needs we should be aware of, please specify.
Price
$50 per day
Lunch available for $7 a day
Days Attending
Every child attending winter camp on December 29th, must have an online waiver filled out Click here for the Urban Air online waiver
Monday, December 29

Urban Air
Tuesday, December 30

iPlay America
Lunch - $7 a day
Monday December 29

Yes, I would like lunch
Tuesday December 30

Yes, I would like lunch
Total

$0.00
Payment
Payment must be paid in full to reserve a spot for your child. Non refundable

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

I give permission for my child to attend all trips and receive medical care in the case of an emergency. Participation in Gan Izzy Day Camp sponsored activities constitutes permission to use photos of participants for promotional purposes.
Permission*

Please check here for Parental/Legal Gaurdian permission
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Child's Information