Camper Information:

First Name: Last Name:

Hebrew Name:

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

Current School: Grade for 2020-2021:

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)

Adult Small

Please list any allergies or medical information that you wish to share 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:

Session 1 (July 6- July 10)

Session 2 (July 13 - July 17)

Session 3 (July 20 -  July 24) 


Payment Information:

I will pay online wit a credit card   I wish to make a 3month 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!