We are so excited to be announcing the opening of Camp Gan Israel's 2023 Session. We have a jam packed schedule of fun and exciting activities, on site enrichment and trips for your child, giving children a wide variety of opportunities each day for a fun and engaging summer. Camp will run for three weeks beginning June 26 - July 14. Camp is closed for July 4th. Camp runs 9:00 a.m.-3:30 p.m. with optional aftercare Monday-Thursday 3:30-5:00 p.m. Aftercare sign up will be sent out closer to camp start date. We are fortunate to be able to offer a limited amount of scholarships with a grant from Jewish Nevada, so apply today! If you have any questions regarding camp, please do not hesitate to contact Rochel 775-283-8552 or Sarah 775-544-8456. Personal Information Child's First Name* Child's Last Name* Hebrew Name Birth Date* Camp Gan Israel is currently taking children ages 4*-12. *Child must be entering Kindergarten. 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Time of Birth Home Address* Mother's Name* Mother's Address* Same as child Different from child Address if Different Mother's Cell Number* Mother's Work Contact Information Father's Name* Father's Address* Same as child Different from child Address if Different Father's Cell Number* Father's Work Contact Information Emergency Contact Name* Emergency Contact Phone Number* Emergency Contact Relationship to child* Contact Email* Please input the preferred email for CGI to be in contact with. I allow my child to be picked up by:* Please list name, relationship to the child and phone number for each person. Insurance Policy Information* Please list name and number of policy. Does your child have any medical conditions?* Yes No If yes, list conditions here: Please include the protocol of how it should be dealt with if there is one. Does your child have any allergies?* Yes No If yes, list protocol here: Please include the protocol of how it should be dealt with if there is one. Has your child had any serious injuries, illnesses or surgeries within the past year?* Yes No If yes, list here: Does your child have any Behavioral Concerns? If yes, please explain. Is there anything else we need to know about your child? Camp Information Entire Session* June 26 - July 14 $675 Discounted Rate for Entire Session Weekly Rates Listed Below Weekly Week 1 6/26-6/30 $275 Week 2 7/3-7/7 $250 Week 3 7/10-7/14 $275 Will you be applying for a scholarship?* Scholarship application can be found at chabadnorthernnevada.com/scholarship Yes No If selected no, please select when you child will be attending camp so payment can be added. Entire Session $675 Week 1 $275 Week 2 $250 Week 3 $275 Payment due May 15th. Click here to make a payment. Supply Fee* Due at Registration $25 Before your child's first day of camp a Camp Gan Israel Waiver will need to be signed. It will be provided to you along with the handbook, calendar, and optional lunch program menu. You can also sign up for extended care at that time. Permissions* In the event of an emergency, to seek medical help for my child, at my expense. Include my child in all photos taken for Camp Gan Israel and any publicity. Allow my child to be transported and participate in all trips if allowed by current regulations. Sign and Date I, the undersigned, as parent/guardian of ___________________, for and inconsideration of the agreement with Aleph Academy and Chabad of Northern Nevada release, acquit, discharge and hold harmless Aleph Academy and Chabad of Northern Nevada and its agents, employees, representatives, successors and assigns, for all manners of claims, demands and damages of every kind and nature whatsoever, which the undersigned my now or in the future have against Aleph Academy/Chabad of Northern Nevada and its agents, employees, representatives, successors or assigns on account of any personal injuries, physical or mental condition, known or unknown, to the person and the treatment thereof, as successors or assigns, including but not limited to their negligence or gross negligence in executing the services above described or in any way incidental thereto. I, the undersigned, do hereby release, indemnify, and hold harmless Aleph Academy/Chabad of Northern Nevada and its affiliates, agents and subsidiaries from any and all actions or claims as a result of any injuries to my child or any other children while participating in Aleph Academy. Total $0.00 Payment Credit Card Custom Schedule/Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Must be paid in full by May 15th. 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