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 InformationChild 1*First NameLast NameBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGender*MaleFemaleSessions:*Week 1Week 2Week 3All three weeksChild 2First NameLast NameBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGenderMaleFemaleSessions:Week 1Week 2Week 3All three weeks2. Parent informationMother's infoFirst NameLast NameCell PhoneArea CodePhone NumberE-mailPrimary emailFather's infoFirst NameLast NameE-mailCell PhoneArea CodePhone Number3. Emergency InformationEmergency ContactFirst NameLast NamePhone NumberArea CodePhone NumberRelationshipPediatrician & InsuranceFirst NameLast NamePhone NumberArea CodePhone NumberInsurancePolicy #4. Payment InformationTotal$0.00PaymentCredit Card Paypal Check/Cash Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearPaypal has been selected. Payment will take place on the next page.Please make checks payable to Chabad of Novato and mail to 695 Delong Ave Suite 101 Novato, CA 94945Agreement*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 allergiesShould be Empty: Submit This page uses TLS encryption to keep your data secure.