Camp Gan Israel Season 2017
Ages 3-10
Camp Registration Form 2017
Parents' names: *
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Best email to be reached at: *
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Home address: *
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Mother's cell: *
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Father's cell: *
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Emergency contact name: *
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Emergency contact number: *
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Name of Camper #1 *
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Camper t-shirt size *
Hebrew and English birth dates of Camper 1: *
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Child's Health Insurance and ID # *
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Name of Camper 2:
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Camper t-shirt size
Hebrew and English Birth dates of Camper 2:
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Child's Health Insurance and ID #
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Name of Camper 3:
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Camper t-shirt size
Hebrew and English Birth dates of Camper 3:
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Child's Health Insurance and ID #
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Name of Camper 4:
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Camper t-shirt size
Hebrew and English Birth date of Camper 4:
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Child's Health Insurance and ID #
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Pediatrician's name and phone number
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Does your child(ren) have any allergies? *
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Please list any medical conditions: *
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Please select the weeks that your child/ren will be participating in camp. *
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*For Maimonides Hebrew Day School parents: Mark with your initials. I give permission for my child’s medical and immunization forms to be copied by the camp nurse from the Maimonides Hebrew Day School files.
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What else should we know about your child?
Comments:
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ALL CAMP WAIVERS MUST BE SIGNED ON THE FIRST DAY OF CAMP IN THE CAMP OFFICE. ADDITIONALLY, YOU MUST PROVIDE CAMP WITH A HEALTH FORM FROM YOUR PEDIATRICIAN.
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Camp fees: Ages 3-4 $150 weekly + $10 trip/transportation fee. Ages 5-10 $125 weekly + $10 trip/transportation fee. $7 t-shirt fee. Swimming fees not included.
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For scholarship forms, please contact Mrs. Clara Simon @ del18clara@gmail.com or 518-439-8280.
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