Mini Gan Izzy (3 & 4 years old) Registration Part 2

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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 18th.

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
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 camp T-shirt size
Optional camp Gan Izzy SWIM SHIRTS
The cost for each swim shirt is $25
How Many Swim Shirts Would You Like To Purchase?
Select the swim shirt size
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 Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Gan Izzy Day Camp Registration - Part Two

A day camp for Jewish children, celebrating our traditions.

Camper Information

Emergency Contact Information.

Child Health Information

T-shirts - $12 each

Parental Consent