Registration - ChabadSunnyvale.com

Registration Date

Month Day Year
How many children will you be registering?*

1 Child2 Children3 Children
Parent Information
Parent 1
Parent 1 Name*
First Name Last Name
Parent 1 E-mail*
Parent 1 Phone Number*

Area Code Phone Number

Parent 1 Address*

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

Parent 2
Household*

Two Parent HouseholdSeparate HouseholdsSingle Parent
Please describe your family's Jewish affiliation*
Parent 2 Full Name*
First Name Last Name
Parent 2 E-mail*
Parent 2 Phone Number*

Area Code Phone Number

Parent 2 Address*

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

Child Information
Child 1
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
School Attending*
Current Grade:*
Any allergies or medical conditions?

YesNo
Please describe in detail*
Any Special Food Requirements?*

YesNo
Please Explain*
Please describe your child's temperament*
Child 1 Registration
Special Promotional pricing expires on June 15th, all registrations must be paid in full by June 15 to qualify for the promotional pricing.
Registration - Promotional Pricing!*

Week 1 - July 10-14Week 2 - July 17-21
Child 1 registering for:*

1 week: $4802 weeks: $9403 weeks: $1,3804 weeks: $1,760
Please specify week(s):*

Week 1: July 1 to July 5Week 2: July 8 to July 12Week 3: July 15 to July 19Week 4: July 22 to July 26
Extended Care Extended care is available daily from 8:00-9:00 AM and 3:30-5:00 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40EARLY CARE Week 3 - $40EARLY CARE Week 4 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80AFTER CARE Week 3 - $80AFTER CARE Week 4 - $80
Extended Care Extended care is available daily from 8:00-9:00 AM and 3:30-5:00 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40EARLY CARE Week 3 - $40EARLY CARE Week 4 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80AFTER CARE Week 3 - $80AFTER CARE Week 4 - $80
Child 2
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
School Attending*
Current Grade:
Any allergies or medical conditions?*

YesNo
Please describe in detail*
Any Special Food Requirements?*

YesNo
Please Explain*
Please describe your child's temperament*
Child 2 Registration
Special Promotional pricing expires on June 15th, all registrations must be paid in full by June 15 to qualify for the promotional pricing.
Child 2 registering for:

1 week: $4802 weeks: $9403 weeks: $1,3804 weeks: $1,760
Please specify week(s):*

Week 1: July 1 to July 5Week 2: July 8 to July 12Week 3: July 15 to July 19Week 4: July 22 to July 26
Registration - Promotional Pricing!*

Week 1 - July 10-14Week 2 - July 17-21
Registration

Week 1 - July 10-14Week 2 - July 17-21
Extended Care Extended care is available daily from 8:00-9:00 AM and 3:30-5:00 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40EARLY CARE Week 3 - $40EARLY CARE Week 4 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80AFTER CARE Week 3 - $80AFTER CARE Week 4 - $80
Extended Care Extended care is available daily from 8:30-9:00 AM and 3:30-4:30 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80
Child 3
Full Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
School Attending*
Current Grade:*
Any allergies or medical conditions?*

YesNo
Please describe in detail*
Any Special Food Requirements?*

YesNo
Please Explain*
Please describe your child's temperament*
Child 3 Registration
Special Promotional pricing expires on June 15th, all registrations must be paid in full by June 15 to qualify for the promotional pricing.
Child 3 registering for:*

1 week: $4802 weeks: $9403 weeks: $1,3804 weeks: $1,760
Please specify week(s):*

Week 1: July 1 to July 5Week 2: July 8 to July 12Week 3: July 15 to July 19Week 4: July 22 to July 26
Extended Care Extended care is available daily from 8:00-9:00 AM and 3:30-5:00 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40EARLY CARE Week 3 - $40EARLY CARE Week 4 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80AFTER CARE Week 3 - $80AFTER CARE Week 4 - $80
Registration - Promotional Pricing!*

Week 1 - July 10-14Week 2 - July 17-21
Registration

Week 1 - July 10-14Week 2 - July 17-21
Extended Care Extended care is available daily from 8:30-9:00 AM and 3:30-4:30 PM

EARLY CARE Week 1 - $40EARLY CARE Week 2 - $40AFTER CARE Week 1 - $80AFTER CARE Week 2 - $80
Scholarship Fund
Please consider helping a struggling family with an optional donation to the Camp Gan Israel Scholarship Fund

$
Payment Information

Lunch and snacks are included.
I would like to request a scholarship.
Mother's Job Description*
Father's Job Description*
Marital Status*
Number of Adults in family*
Number of Children in Family*
Total Annual Income*
Please Explain the Financial Difficulty*
How Many Children Are you Sending to Gan Izzy?*
How many weeks will they be attending?*
What is the amount of total camp tuition?*
How much can you pay towards camp tuition?*
*

I confirm that all the information contained above is accurate to the best of my knowledge and I understand that if this information is found to be false I may be disqualified from receiving aid and may be required to return any funds received.
Signature*
Date/Submission

Month Day Year
at Hour Minutes
E-mail for Response*
Email for us to send a response and related communication to
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Please select a payment plan for the remaining balance

Pay in Full nowPay only Deposit now; the remaining balance will be divided into equal monthly installments. Installments will be charged on the 15th of each month with final payment on June 15th.Pay only Deposit now; remaining balance in full by June 15th.
Registration Terms, Conditions & Waivers
Health Guidelines

I agree to follow all the health guidelines in place at camp this this summer, and to not bring my children to camp if they are displaying a fever, vomiting, diarrhea or other flu symptoms.

Parental Consent

Parental consent for participation in all activities of Camp Gan Israel is fully implied unless specifically excluded during the registration process.

Payments & Cancellations

All camp registrations require payment in full prior to June 15th. Should payment not be satisfied in full, space in the program is not saved and your child may lose their place in our program.

Refund policy:

Cancelations Prior to June 21st : If cancelation results in no attendance at Camp Gan Israel for this child, all camp fees will be refunded minus the $100 registration fee. If child is still attending some weeks, refund will be in full, minus a $25 fee for each canceled week.

Cancelations After June 21 st : 25% refund of weeks of camp canceled.
Change of weeks: $25 fee per week.

Please Note: We are unable to offer any refunds for illness of a camper that prevents him/her from attending our program. If Camp Gan Israel is forced to cancel or temporarily close a program due to an infection, Camp Gan Israel will offer a full refund for unused days (prorated) to all campers affected. Only those campers (and siblings) who are directly affected by the closure will be offered a refund.

Dismissal of a Camper

Camp Gan Israel reserves the right to dismiss, at its sole discretion, any camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of the camp or fellow campers or who violates camp rules and regulations, in which case no refunds will be made.

Medical Care

In the event of an emergency, serious illness, or accident, Camp Gan Israel has permission to arrange for any necessary first-aid or care by a licensed physician for any child/ren attending camp. Every effort will be made to contact the parent/guardian and emergency contacts first. Should it be necessary for the well-being of the camper to utilize outside medical or dental services all expenses involved will be paid for by the parent.

Parents are required to notify CGI in a timely manner of any infectious diseases or infestations acquired by a camper during their participation at camp.

Images Etc.

Unless I state otherwise (in the form of an email or other written format), I give Camp Gan Israel & Chabad of Sunnyvale the right to use in promoting the Camp and in other ventures directly relating to the Camp including the Camp Gan Israel Facebook page (i) digital, photographic, video, and audio images or likenesses of camper; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by Camper or originating from Camp or from a Camp-related activity.

Indemnify & Hold Harmless

I agree to indemnify and hold harmless Camp Gan Israel, Chabad of Sunnyvale and its officers, employees, volunteers or assigns from any liability concerning my child’s involvement in camp and further agree that the use of any premises during the program is made at my own risk.

By checking the box below, I certify that I have legal capacity to act as the parent/guardian of the named minor. I further understand that the terms of this agreement are legally binding and certify that I am signing this agreement, after having carefully read it, of my own free will.
Signature*
Accident
As the parent(s) or legal guardian of my/our child, I/we authorize any adult acting on behalf of Camp Gan Israel to hospitalize or secure treatment for my child; I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Camp Gan Israel personnel will try, but are not required to communicate with me prior to such treatment.
Agreement*

I agree.
Date:

Month Day Year
Trips & Outings
I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Camp Gan Israel.
Agreement*

I agree.
Date:

Month Day Year
Privacy
I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, Camp Gan Israel and Chabad of Sunnyvale website and Camp Gan Israel and Chabad of Sunnyvale social media. I understand that I can withdraw my consent at any time.
Agreement*

I agree.
Date:

Month Day Year
Should be Empty:

This page uses TLS encryption to keep your data secure.

Parent Information

Child Information

Scholarship Fund

Payment Information

Registration Terms, Conditions & Waivers

Accident

Trips & Outings

Privacy