Registration - chabadofthemountains.com

Rates

Weekly Rate: $310

10% Sibling Discount

Early Bird (Until March 31): $285

You will be charged only after your child is accepted to camp
Camp Gan Izzy Registration- Summer 2025
How many children will we be signing up today?*
Parent Information
Parent 1
Full Name*
First Name Last Name
E-mail*
Phone Number*
Parent 2
Full Name
First Name Last Name
E-mail
Phone Number
Child Information
Full Name*
First Name Last Name
Hebrew Name*
Gender*

MaleFemale
Birth Date*

Month Day Year
School Attending*
Grade completing*
I'd like to sign my child up for*

Week 1 (June 30- July 4)Week 2 (July 7- July 11)Week 3 (July 14- July 18)Week 4 (July 21- July 25)Week 5 (July 28-July 31)
Camp T-shirt size*

Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult L
Child #2 Information
Full Name*
First Name Last Name
Gender*

MaleFemale
Birth Date*

Month Day Year
School Attending*
Grade completing*
I'd like to sign my child up for*

Week 1 (June 30- July 4)Week 2 (July 7- July 11)Week 3 (July 14- July 18)Week 4 (July 21- July 25)Week 5 (July 28-July 31)
Camp T-shirt size*

Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult L
Child #3 Information
Full Name*
First Name Last Name
Gender*

MaleFemale
Birth Date*

Month Day Year
School Attending*
Grade completing*
I'd like to sign my child up for*

Week 1 (June 30- July 4)Week 2 (July 7- July 11)Week 3 (July 14- July 18)Week 4 (July 21- July 25)Week 5 (July 28-July 31)
Camp T-shirt size*

Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult L
Child #4 Information
Full Name*
First Name Last Name
Gender*

MaleFemale
Birth Date*

Month Day Year
School Attending*
Grade completing*
I'd like to sign my child up for*

Week 1 (June 30- July 4)Week 2 (July 7- July 11)Week 3 (July 14- July 18)Week 4 (July 21- July 25)Week 5 (July 28-July 31)
Camp T-shirt size*

Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult L
Family background*

Interested in JudaismMother is Jewish
Are there conversions in the family?*

YesNo
If yes please specify
Transportation needed ($50 week)

Week 1Week 2Week 3Week 4Week 5
Summer Community*

Big Bass LakeEagle LakeHemlock FarmsHideoutLake Naomi

Poconos Summer Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Health Information
Is your child taking any medications?*

YesNo
Has your child had any major surgeries in the past?*

YesNo
Does your child have any allergies?*

YesNo
If yes, please provide details
Child #2
Is your child taking any medications?*

YesNo
Has your child had any major surgeries in the past?*

YesNo
Does your child have any allergies?*

YesNo
If yes, please provide details
Child #3
Is your child taking any medications?*

YesNo
Has your child had any major surgeries in the past?*

YesNo
Does your child have any allergies?*

YesNo
If yes, please provide details
Child #4
Is your child taking any medications?*

YesNo
Has your child had any major surgeries in the past?*

YesNo
Does your child have any allergies?*

YesNo
If yes, please provide details
Pediatrician Information
Full Name*
First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
Waivers
*

The health history that I have provided is correct and accurately reflects the health status of the camper to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations.
*

If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a 'need to know' basis with camp staff. I give permission to print this information. In addition, camp has permission to obtain a copy of my child's health record from providers who treat my child and these providers may talk with the program's staff about my child's health status.
Emergency Contacts
Contact 1
Full Name*
First Name Last Name
Phone Number*
Contact 2
Full Name
First Name Last Name
Phone Number
Terms, Conditions, and Waivers
Please read this information and agreement carefully before registering to Camp Gan Izzy. By submitting your registration, you are agreeing to the following terms, conditions, and waivers.
Please check off the boxes*

Health Guidelines- I agree to follow all the health guidelines in place at camp this summer including checking my child's temperature before coming to camp each morning and not brining them in if they are displaying a fever, vomiting, diarrhea or other flu symptoms; or after traveling out of the area or being aroound someone who may have the virus. I understand that all children may be subjected to a health screening before entering camp each morning including an electronic temperature check, and they will be sent home if a fever is found
*

Parental Consent- Parental consent for participation in all activities of Camp Gan Izzy is fully implied.
*

Payments and Cancellations- All camp registrations require a scheduled payment plan to be confirmed. Without a payment schedule registrations are not saved and your place is not confirmed. Refund policy: Camp Gan Israel offers complete refunds of all fees up until one week before your program start date minus a $75 cancellation fee. To cancel a session please contact our office. Other cancellations: no refunds available from 7 days before program start date. Please note: We are unable to offer any refunds for illness of a camper that prevents him/her from attending our program. If Camp Gan Israel is forced to cancel or temporarily close a program due to an infection, Camp Gan Israel will offer a full refund for unused days (prorated) to all campers affected. Only those campers (and siblings) who are directly affected by the closure will be offered a refund.
*

Dismissal of a Camper- Camp Gan Israel reserves the right to dismiss at its sole discretion, any camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of the camp or fellow campers, or who violates camp rules and regulations, in which case no refunds will be made.
*

Medical Care- In the event of an emergency, serious illness, or accident, Camp Gan Israel has permission to arrange for any necessary first-aid or care by a licensed physician for any children attending camp. Every effort will be made to contact the parent/guardian and emergency contacts first. Should it be necessary for the well being of the camper to utilize outside medical or dental services all expenses involved will be paid for by the parent. Parents are required to notify CGI in a timely manner of any infectious diseases or infestations asquired by a camper during their participation of camp.
*

Images Etc.- Permission is hereby given for Camp Gan Israel to use in promoting the camp and in other ventures directly relating to the camp including the Camp Gan Israel Facebook page (i) digital, photographic, video, and audio images or likenesses of camper, and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos creataed by camper or originating from camp or from a camp- related activity.
*

Indemnify and Hold Harmless- I agree to indemnify and hold harmless Camp Gan Israel and its officers, employees, volunteers, or assigns from any liability concerning my child's involvement in camp, and further agree that the use of any premises during the program is made at my own risk. By signing this agreement, I certify that I have legal capacity to act as the parent/guardian of the named minor. I further understand that the terms of this agreement are legally binding and certified that I am signing this agreement after having carefully read it of my own free will.
Comments/questions:
Payment
Payment plan will be emailed upon acceptance
please send me a scholarship form
*

I agree to save my card for future transactions.
Payment options* payments must be received in full by June 1

Charge my credit card upon acceptanceDivide my payment equally and charge me on the first of each month through June 1

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Camp Gan Izzy Registration- Summer 2025

Parent Information

Child Information

Child #2 Information

Child #3 Information

Child #4 Information

Health Information

Child #2

Child #3

Child #4

Pediatrician Information

Waivers

Emergency Contacts

Terms, Conditions, and Waivers

Payment