Camp Gan Israel Summer 2022 - Chabad Lubavitch of British Columbia

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Vancouver Camp Gan Israel 2022 Registration Form
Your Name*
First NameLast Name
How many children are you registering?*
Camper 1 Info
Full Name*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
School*
Grade Entering in September 2022*
Medical Information*Allergies, Medications etc
Camper 2 Info
Full Name*
First NameLast Name
Birth Date
MonthDayYear
Gender*
MaleFemale
School*
Grade Entering in September 2022*
Medical Information*Allergies, Medications etc
Camper 3 Info
Full Name*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
School*
Grade Entering in September 2022*
Medical Information*Allergies, Medications etc
Family Information
Parent 1 Name*
First NameLast Name
Parent 2 Name
First NameLast Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number
Area CodePhone Number
Parent 1 E-mail*
Parent 1 Cell Number*
Area CodePhone Number
Parent 2 E-mail
Parent 2 Cell Number
Area CodePhone Number
Emergency contact other than parents
Contact 1
Full name*
First NameLast Name
Relationship to child*
Cell phone*
Area CodePhone Number
Contact 2
Full Name
First NameLast Name
Relationship to child
Cell Phone
Area CodePhone Number
Camp Shirts - Shirts are mandatory for field trips.
Camp Shirt Size for Child 1
Please select
Short SleeveLong Sleeve
Number of Camp Shirt
Camp Shirt Size for Child 2
Please select
Short SleeveLong Sleeve
Number of Camp Shirt
Camp Shirt Size for Child 3
Please select
Short SleeveLong Sleeve
Number of Camp Shirt
Session(s) For Child 1
Please Select Sessions for Child 1*
Full Summer (July 4-August 12)July 4-8 (Week 1)July 11-15 (Week 2)July 18-22 (Week 3)July 25-29 (Week 4)August 2-5 (Week 5)August 8-12 (Week 6)
Session(s) For Child 2
Please Select Sessions for Child 2*
Full Summer (July 4-August 12)July 4-8 (Week 1)July 11-15 (Week 2)July 18-22 (Week 3)July 25-29 (Week 4)August 2-5 (Week 5)August 8-12 (Week 6)
Session(s) For Child 3
Please Select Sessions for Child 3*
Full Summer (July 4-August 12)July 4-8 (Week 1)July 11-15 (Week 2)July 18-22 (Week 3)July 25-29 (Week 4)August 2-5 (Week 5)August 8-12 (Week 6)
Half or full day for kids born in 2018, 2019 (Please refer to information below)
Half DayFull Day
Your card will be charges $20/kid non-refundable registration fee. No other amounts will be charged until our office has confirmed with you
Total
$0.00 CAD

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Any other information we need to know about your child?
Should be Empty:

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Vancouver Camp Gan Israel 2022 Registration Form

Family Information

Emergency contact other than parents

Contact 1

Contact 2

Camp Shirts - Shirts are mandatory for field trips.

Session(s) For Child 1

Session(s) For Child 2

Session(s) For Child 3