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Winter Camp II 2015 Registration

Camper/Parent Information
Child 1 Name
First
Middle
Last
DOB
       Age:
Child 2 Name
First
Middle
Last
DOB
       Age:
Child 3 Name

First
Middle
Last
DOB
       Age:
Address
Street
City
State, Zip
Contact Info
Phone
Email
Schools
School
Hebrew School Grade:
Child's Mother
Mother's Name
Work Phone
Cell
Child's Father
Father's Name
Work Phone
Cell
Emergency Contact Info
Name
Phone
Relationship
Pediatrician
Name
Phone
 

Email

 

 

Winter Camp Fees & Dates:
 
 
Fees
$175 Full Week
$40 a Day
Camp Dates

 10:00am - 4:00pm
Please check the days that your child will be attending:
Monday, February 16  
Tuesday, February 17 
Wednesday, February 18
Thursday, February 19
Friday, February 20 (Early dismissal: 2:00 PM)

From 10:00am - 4:00pm

 Camp T-shirt - $10 (mandatory)

**Note: Please complete the camp lunch form for meal requests.  Thank you!** 

Payment and agreements
All forms must be completed and submitted for the Winter Camp in order to secure a place for your child.

Credit Card Number  Exp  CVV
If the billing address does not match address above, please fill it out in the comments section below.
Promo Code: 
Total $ (including T-shirt)

I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
Also, I give FREE Winter Camp permission to photograph and videotape my children and use the photos and videos for whatever the camp sees fit.

 

Print name of parent filling out form

After you form is complete please fill out the lunch form.
Comments:

 

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Ganeinu Day Camp 4230 Middlebelt Road West Bloomfield, MI 48323 248-932-8584
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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