Register Online! - Chabad of Bethesda
« Back to Chabad of Bethesda

CAMP GAN ISRAEL of BETHESDA
Summer 2015 Online Registration

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

In order to receive the Early Bird Discount you will need to submit a $100 Security Deposit for each child, you will be provided instructions when you press submit for this form.

>Click here for a printable version of the registration form

Note: Please use a separate form for each child.

Camper/Parent Information

Name

 

First

Middle

Last
 

Address

 

Street

City

State

Zip*

DOB

 

 Age in camp 

Contact Info

 

Home 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

 Address
 
 

Medical Info

 

Allergies / Medical Conditions

 Medications

 

 

 

 

 

 

Select Child's Age Group
 
 Ages 4        
Ages 5-9
Ages 10-13  
 
 
Please indicate sessions your child will attend camp (check all that apply):
Ses 1: Jun 22-Jul 3     Ses 2: Jul 6-Jul 17    Ses 3: Jul 20-Jul 31       Xtra Wk: Aug 3 - Aug 7 

Half Day Option: 9:00am - 1:00pm (Ages 4 only)  
 
 
Conditions of Enrollment and Parental Release

 

A. The camper and parents agree to abide by the rules and regulations set by the camp for the health, safety and welfare of the campers.

B. The camp is not responsible for articles of clothing, or personal belongings lost or damaged.

C. The camp will make every effort to protect the health and safety of every camper. However, it will not be responsible for the injury or health impairment of any camper. Therefore, it is understood the Camp Gan Israel cannot assume responsibility for accidents or losses, as a non-profit organization, and I do hereby release the Camp Gan Israel from any liability for injury or loss to my child.

D. In case of emergency, doctors and hospitals may refuse to treat a minor unless the expressed prior consent of a parent or legal guardian has been obtained. Because of the possibility of being unable to reach a parent in an emergency, we request your permission (as indicated by your signature below) to exercise our best judgment in this matter, but without liability for such a determination.

E. No refund shall be given in the instance where a camper starts later than the agreed upon date of commencement or misses a regularly scheduled camped day. No refund shall be made in the instance where a camper terminated attendance earlier than the agreed upon date, unless it is in the Camp Director’s judgment that such earlier termination is necessary due to illness or other cause. In such an event a refund may be made not exceeding 50% camp fees.

I do give my child permission to participate in the Camp Gan Israel, which includes field trips where campers may walk or be conveyed by other modes of transportation. I also permit my child to take part in all other activities that are included in the Camp Gan Israel. The above releases from liability also apply here, as well. 
 

Your Initials:

Date:
I have read and agree to the above-stated terms. I hereby give my child permission to participate in Camp Gan Israel including field trips (and modes of conveyance determined by the camp), activities, and the receiving of any medical care in the case of emergency.


IN ORDER TO RECEIVE EARLY BIRD BONUS YOU WILL NEED TO SUBMIT A $100 SECURITY DEPOSIT, INFORMATION ON CONFIRMATION PAGE