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Register Online

Register Online

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Camp Gan Israel - Chabad of Pinellas County
Online Registration

Note: Please use a separate form for each child.

Camper/Parent Information
Name
First
Middle
Last
Age
Address
Street
City
State
Zip
Date of Birth
Contact Info
Phone
Email
Schools
School
Hebrew School
Entering Grade:
Child's Mother
Mother's Name
Hebrew Name
Work Phone
Cell
Child's Father
Father's Name
Hebrew Name
Work Phone
Cell
Emergency Contact Info
Name
Phone
Relationship
Pediatrician
Name
Phone

Comments

Select Child's Age Group
Camp Gan Israel - Ages 5-11
Kiddie Camp - Ages 2-4
Please indicate number of weeks your child will attend camp:
Week 1 (June 27 - July 1)

Week 2 (July 4 - July 8)

Week 3 (July 11 - 15)

Week 4 (July 18 - 22)

Entire Summer (June 27 - July 22)

Rates:

• Main Camp $160 Per Week • $600 for entire summer. 9:00am - 3:30pm
Early Bird Discount (Register before April 24):
$150 Per Week • $560 for entire summer

• Early and extended care available (8:30am - 4:00pm - $30 per week). If you are interested please put it in the comment's.

IMPORTANT
Upon receipt of this form, we will send you a packet of important camp information and forms.
All forms must be completed and submitted before your child begins camp.
There is a $50 non-refundable registration fee which must accompany this form.
(For current Hebrew school children the fee is waived)
I will pay this fee by: Credit Card (Fill in information below).
Check (Please send to 3696 Fisher Rd. Palm Harbor, FL 34683 ATTN: CGI)
Credit Card Information:

First Name on card:

Last Name on card:

Billing Address:

City:

State:

Zip:

Amount to be charged Please indicate whether you will be paying for full summer or only registration fee

Card Type

Card Number

Expiration Date

CVV Security Code

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All fields required.

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