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Gan Izzy Summer Day Camp, Bucks County - online registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

PLEASE NOTE: To secure a spot for your child, a $60 non-refundable
registration fee is required per camper.

Camper/Parent Information
Name
  First
Middle Last

Gender

Female Male

Address
  Street
City State
Zip
Date of Birth
   
Contact Info
  Home Phone
   
Schools
  School
Hebrew School (if applicable)

Entering Grade in September 2017 

Child's Mother
  Mother's Name
Work Phone Cell
Mother's Email
Child's Father
  Father's Name
Work Phone Cell

Father's Email

Emergency Contact Info
  Name
Phone Relationship  
Pediatrician
  Name
Phone    

 

       
           
 
 
 
 
   
How did you hear of Gan Izzy?
online
mailing
friend

other

 
 
Please indicate number of sessions your child will attend camp:
 
     
IMPORTANT
To secure a spot for your child, a $60 non-refundable registration fee is required per a camper.
 

I will be paying by: Mastercard Visa Discover Amex

I will send in a Check

in the Amount of

Card Number

Expiration Date (mm/yy)

Security code (The 3 or 4 digit is located inside the signature box on the back of your card immediately after your c.c. number)

I have read the camp brochure and application form 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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Camp Gan Izzy • 25 N State Street • Newtown, PA 18940 • 215-497-9925 ext:13 - Gan Izzy summer day camp of Bucks County offers a range of exciting activities, field trips, swimming, sports, crafts, and workshops all in a warm and caring environment.
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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