Winter Camp Registration | www.jewishkids.club

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Parent 1

First Name *

Last Name *

Street Address *

City *

Postal Code *

State/Province *

Phone Number *

Phone Number 2

Email *

Is Jewish

Yes

No

Parent 2

Existing Contact

First Name

Last Name

Street Address

City

Postal Code

State/Province

Phone Number

Phone Number 2

Email

Is Jewish

Yes

No

Child 1

Existing Contact

First Name

Last Name

Gender

Birth Date

Month

Day

Year

Hebrew Name

Example: David or דוד

Camp session

Gan Israel Summer 2022

Participant Fee

1 week - $350

2 weeks (full session) - $700

Child health info

Health insurance name

Health insurance number

Allergies

Please list any medical and/or behavioral issues

Child info

Name of School

Grade

Child 2

Existing Contact

First Name

Last Name

Birth Date

Month

Day

Year

Hebrew Name

Example: David or דוד

Camp session

Gan Israel Summer 2022

Participant Fee

1 week - $350

2 weeks (full session) - $700

Child health info

Health insurance name

Health insurance number

Allergies

Please list any medical and/or behavioral issues

Child info

Name of School

Grade

Child 3

Existing Contact

First Name

Last Name

Hebrew Name

Example: David or דוד

Camp session

Gan Israel Summer 2022

Participant Fee

` weeks (full session) - $350

2 weeks (full session) - $700

Child health info

Health insurance name

Health insurance number

Allergies

Please list any medical and/or behavioral issues

Child info

Name of School

Grade

Emergency contact

First Name

Last Name

Phone Number

Jewish Kids Club

office@jewishkids.club | 510-225-4005 | Non profit 501(c)(3) ID # 83-0945973

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