« Back to Chabad Jewish Center of Novato

ב"ה

Register

We are thrilled to have you join Camp Gan Israel of Marin summer 2022!
Week 1: June 20 - June 24
Week 2: June 27 - July 1
Week 3: July 4 - July 8
Join for all 3 weeks and receive a $50 discount!
If you have financial hardships, please reach out to [email protected] to see if their is any scholarships available
1. Child/ren’s Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Sessions:*
Week 1Week 2Week 3All three weeks
Child 2
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Sessions:
Week 1Week 2Week 3All three weeks
2. Parent information
Mother's info
First NameLast Name
Cell Phone
Area CodePhone Number
E-mailPrimary email
Father's info
First NameLast Name
E-mail
Cell Phone
Area CodePhone Number
3. Emergency Information
Emergency Contact
First NameLast Name
Phone Number
Area CodePhone Number
Relationship
Pediatrician & Insurance
First NameLast Name
Phone Number
Area CodePhone Number
Insurance
Policy #
4. Payment Information
*
Last minute registration fee $50
Total
$0.00

Payment

Credit Card Paypal Check/Cash

Agreement*
I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Gan Israel permission to photograph and videotape my children and use the photos and videos (without their names) for newsletters.
General comments - please include any allergies
Should be Empty:

This page uses TLS encryption to keep your data secure.