Camp Gan Israel: Simi  Valley - Registration

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Please fill out this form as an initial registration for the Camp Gan Israel

Confirmation of acceptance will be acknowledged only after this registration form is
reviewed and an acceptance letter is received.

Student Information

Male Female

What school does your child attend? Grade entering:
Are the natural mother and father of the child Jewish? Mother ____ Father _____  If not,

please explain ________________________________________________________________________________


Any considerations, such as learning disorder or difficulty, the school should be aware of?


Parent Information


Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).

Please send a copy of your insurance card for our files.

Up to date with vaccinations? Yes No Date of last tetanus shot:

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Camp Gan Israel Tuition Agreement

The following is a tuition agreement for the Camp Gan Israel. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for Camp Gan Israel is $180 per child.

Discounts: There is a 10% discount off of the regular tuition for each additional child of the same family. There is a 10% additional discount off your total tuition for each child of another family you successfully introduce to Camp Gan Israel.


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Your FULL name here:

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Check or Card No.

Check Date or Card Expiration: mm/yyyy /

I heard about the Camp Gan Israel from: