Gan Izzy 2019 begins Monday, July 1!!
Reminder to wear your Gan Izzy tshirts on Thursdays for field trips!
First Name: Last Name:
Birthdate: Current Age:
Hebrew Birthdate (if known):
Current School: Grade for 2019-2020:
Please Select A T-Shirt Size:
Youth Extra Small (size 4)
Youth Small (size 6-8)
Youth Medium (size 10-12)
Youth Large (size 14-16)
Please list any allergies or medical information that you wish to share about your child:
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:
Please indicate which sessions your child will be attending:
Session 1 (July 1- July 5)
Session 2 (July 8 - July 12)
Session 3 (July 15 - July 19)
Session 4 (July 22 - July 26)
I will pay online wit a credit card I wish to make a 4 month payment plan
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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