Register

Address

Address

Address

Health Information
Child’s Physician or Medical Facility (name):
Phone Number

Area Code Phone Number
List any serious illnesses your child(ren) had within the past six months, including noting if your child(ren) has had history of physical handicaps, rheumatic fever, heart problems, seizures, asthma, diabetes, or other problems.
Does your child(ren) have any allergies? If yes, please describe them and indicate special precautions or care needed
Please describe any instructions that would be helpful in caring for your child, or special medical information needed by the child’s care staff/provider.
Registration Policies and Parental Consent
I hereby permit Camp Gan Israel to transport my child(ren) on camp provided transportation, and to obtain emergency medical care as the situation mandates. I allow my child to participate in all camp activities. I allow Camp Gan Israel to use my child(ren)’s photograph for all promotional purposes. I understand that tuition balance must be paid in full by the arranged with the Camp Director.
I agree
Inital
Date

Month Day Year
Deposit Payment
Total Deposit

* For more than two campers, please email camp @chabadtoledo.com with additional campers names and ages.

Payment

Credit Card Paypal

Postal / Zip Code

Country

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