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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
- None -
Female
Male
Other
Birth Date
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
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Year
Year
1922
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2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
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
- None -
K
1
2
3
4
5
6
Child 2
Existing Contact
First Name
Last Name
Birth Date
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
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
- None -
K
1
2
3
4
5
6
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
- None -
K
1
2
3
4
5
6
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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