Apply Now Contact Us
PrintSend this page to a friendShare this


Winter Camp II 2014 Registration

Camper/Parent Information
Name

DOB
First
Middle
Last
Name

DOB
First
Middle
Last
Name

DOB
First
Middle
Last
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:
Early Bird Special: (by Feb 12)
 
Fees
(after Feb 12)
   

 $40 a day
Full Week: $165

$45 a day
Full Week: $200 
  

Camp Dates


10:00am - 4:00pm
Please check the days that your child will be attending:
Monday, Feb 17  
Tuesday, Feb 18   
Wednesday, Feb 19 
Thursday, Feb 20
Friday, Feb 21

From 10:00am - 4:00pm

NEW! Camp Sweatshirt - $14.00, early bird special $12.00 (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 CC billing address does not match address above, please fill it out in the comments section below.
Total $ (including sweatshirt)

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:

 

Secure This page uses 128 bit SSL encryption to keep your data secure.

PrintSend this page to a friendShare this

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

Powered by Chabad.org © 1993-2014 Chabad-Lubavitch Media Center. All rights reserved.

staff form