Register Online! | Camp Gan Israel Bethesda-Chevy Chase

CAMP GAN ISRAEL of B-CC
Summer 2012 Online Registration

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

>Click here for a printable version of the registration form

Note: Please use a separate form for each child.

Camper/Parent Information
Name		First	Middle	Last
Address		Street	City	State	Zip*
Date of Birth					Age
Contact Info		Home Phone	Email
Schools		School	Hebrew School	Entering Grade:
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	Address
Medical Info		Allergies / Medical Conditions		Medications

Select Child's Age Group
	Ages 2-4		Ages 5-9	Ages 10-13

Please indicate sessions your child will attend camp (check all that apply):
Ses 1: June 25 -July 6 Ses 2: July 9 - July 20 Ses 3: July 23-Aug 3 Extra Wk: Aug 6- Aug 10 Half Day Option: 9:30am - 1:00pm (Ages 2-4 only)

Conditions of Enrollment and Parental Release
A. The camper and parents agree to abide by the rules and regulations set by the camp for the health, safety and welfare of the campers. B. The camp is not responsible for articles of clothing, or personal belongings lost or damaged. C. The camp will make every effort to protect the health and safety of every camper. However, it will not be responsible for the injury or health impairment of any camper. Therefore, it is understood the Camp Gan Israel cannot assume responsibility for accidents or losses, as a non-profit organization, and I do hereby release the Camp Gan Israel from any liability for injury or loss to my child. D. In case of emergency, doctors and hospitals may refuse to treat a minor unless the expressed prior consent of a parent or legal guardian has been obtained. Because of the possibility of being unable to reach a parent in an emergency, we request your permission (as indicated by your signature below) to exercise our best judgment in this matter, but without liability for such a determination. E. No refund shall be given in the instance where a camper starts later than the agreed upon date of commencement or misses a regularly scheduled camped day. No refund shall be made in the instance where a camper terminated attendance earlier than the agreed upon date, unless it is in the Camp Director’s judgment that such earlier termination is necessary due to illness or other cause. In such an event a refund may be made not exceeding 50% camp fees. I do give my child permission to participate in the Camp Gan Israel, which includes field trips where campers may walk or be conveyed by other modes of transportation. I also permit my child to take part in all other activities that are included in the Camp Gan Israel. The above releases from liability also apply here, as well.
Your Initials: Date:	I have read and agree to the above-stated terms. I hereby give my child permission to participate in Camp Gan Israel including field trips (and modes of conveyance determined by the camp), activities, and the receiving of any medical care in the case of emergency.