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Gan Izzy Winter Fun Days will be on December 30 & 31.

Ages 3+ (potty trained)

9:30 am - 3:00 pm

Camper Information:

First Name: Last Name: Hebrew Name:

Birthdate: Current Age: Hebrew Birthdate (if known):

Current School: Grade for 2014-2015:

Please list any allergies or medical information that needs to be shared about your child:

Family Information:

Home Address: City/State/Zip:

Mother's First Name: Mother's Last Name:

Mother's Hebrew Name:

Father's First Name: Father's Last Name:

Father's Hebrew Name:

Contact and Emergency Information:

Email Address For Camp Related Information:

Home Phone Number:

Mother's Cell Phone Number: Mother's Work Number:

Father's Cell Phone Number: Father's Work Number:

Emergency Contact: Relationship to Camper:

Phone Number For Emergency Contact:

Please indicate who we should call first if we need to reach you:

Enrollment Information:

Please indicate which sessions your child will be attending:

December 30

December 31

$18 per day when paid and registered by Decemeber 7. Price goes to $36 per day on December 8.

Payment Information:

I will pay online wit a credit card (must pay by Dec 7 to get special sale price)

I will mail a check to 1920 Colley Avenue, Norfolk, VA 23517

Credit Card Information:

Name as it appears on card:

Billing zip code for card: Type of Card:

Card Number: Expiration: CV Code:

I authorize Chabad of Tidewater to charge my card in the amount of .

Thank you for enrolling in Camp Gan Israel - we can't wait to see you in camp!

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Camp Gan Israel 1920 Colley Avenue Norfolk, VA 23517 757-616-0770
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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