Gan Israel Spring Camp 2008


Please fill out the online registration form below carefully.

Use a separate form for each child.

If you wish to do it offline, Click here for a PDF Registration Form.   
Once filled out completely, please fax ASAP to our office: 403-281-0338   

Camper/Parent Information
Name

 
Hebrew
 
  

First


Middle

 

 

Last

 

 
Gender
Boy
Girl
 
 
Address
   Street
City Province Zip
Date of Birth
      Age
Contact Info
   Phone
Email
 
Schools
   School
Hebrew School Grade Finished:
Child's Mother
   Mother's Name
Hebrew Name Work Phone Cell
Child's Father
   Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
   Name
Phone Relationship  
Pediatrician
   Name
Phone    

Email

      

 Alberta Health #

          

 

            

  

Please check off the days your child will be attending?

Day 1, Monday March 24          $37.00*

Day 2, Tuesday March 25         $37.00*

Day 3, Wednesday March 26     $37.00*

Day 4, Thursday March 27        $37.00*

Day 5, Friday March 28             $37.00*

* Add $2.00 per day after March 17

SPECIAL PROMOTIONAL DISCOUNT

  5% off for each additional sibling
PAYMENT
 
 

All forms must be completed and submitted before your child begins camp.

Sub Total                    $     
Minus discounts            $  

GRAND TOTAL            $ 

 
 

Card Type       

Card Number     

Expiration date   

I have read the camp brochure, application form, and 'Dates and Rates' and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
   
  Date of Application:




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