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Online Application 2017

  • Please fill out the form below carefully. 
  • When you press submit, this form will be sent to the camp office. 
  • Camp personnel will contact you by email within one week of receiving 
    your registration. 
  • Payments can be made online (see our Online Payment Form) or mailed to: 
    Camp Gan Israel, 770 Howes Lane, Columbia, MD 21044.
  • All campers will need a copy of their Immunization Records
    Health Inventory Form and an Emergency Form before the first day of camp. 
    You can download a copy of these forms by clicking on the above links or by getting a copy from your child's school. Returning campers do not need a new Health Inventory Form. 

 

Camper/Parent Information

Camper 1 Name 
First  Middle  Last  

Male  
Female 

Date of Birth 

(Optional) 
Hebrew Birthday  
If unknown; please write time of birth and we can calculate it for you! 

School  Hebrew School  
Entering Grade in September 2017 

 

Camper 2 Name 
First  Middle  Last  

Male  
Female  

Date of Birth 

(Optional) 
Hebrew Birthday  
If unknown; please write time of birth and we can calculate it for you! 

School  Hebrew School  
Entering Grade in September 2017 

 

Camper 3 Name 
First  Middle  Last  

Male  
Female  

Date of Birth 

(Optional) 
Hebrew Birthday  
If unknown; please write time of birth and we can calculate it for you! 

School  Hebrew School  
Entering Grade in September 2017 

 

Contact Info

Address

Street  City  State  Zip 

Phone  Email 

 


Mother's Information:

Mother's Name  Hebrew Name  
Jewish Status 
Work Phone  Cell  
Occupation  Work Address  
Work Email  

 

Father's Information:

Father's Name  Hebrew Name  
Jewish Status 
Work Phone  Cell  
Occupation  Work Address  
Work Email 

 

Pediatrician

Name  Phone 

Does your child/ren have any allergies? Yes No 

Please download the Allergy Protocol Form for each child with any Allergies by CLICKING HERE

Camp Gan Israel requests that your child arrived to camp with sunscreen applied to all exposed areas of his/her body. However re-aplication of sunscreen may be necessary during the camp day.

I hereby grant permission to Gan Israel day camp counsellors and staff to apply sunscreen to my child. I am aware that it is my responsibility to provide sunscreen to Gan Israel day camp.

I consent:  Print Name: 

I give permission to my child to be accompanied by members of the staff of Camp Gan Israel on trips off campus, for field trips or lunch outings during summer camp.

I consent:  Print Name: 

I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

I consent:  Print Name: 

I hereby give consent to the administration of Camp Gan Israel to take and post pictures of my child for camp and publicity purposes.

I consent:  Print Name: 

Please list anything else you would like to inform Camp Gan Israel about your child (Social/Emotional/Behavioral issues/special needs etc.):

Weeks Attending Camp:

Session 1: 
 Week 1 (June 26 - June 30) 
 Week 2 (July 3 - July 7) *No camp July 4th

Session 2: 
 Week 3 (July 10 - July 14) 
 Week 4 (July 17 - July 21)

Session 3: 
 Week 5 (July 24 - July 28)
 Week 6 (July 31 - Aug 4) *No camp Tisha B'Av - August 1st

Days Attending Camp:


Please Specify days of attendance if NOT attending full week (Preschool age only)

Full Day/Half Day:

 Attending Full Day 9:30 - 4:00
 Attending Half Day 9:30 - 12:30 (Only available for Preschool age)

Thank you very much. 
Looking forward to a fantastic summer!