Parent informationHome Phone Number*Area CodePhone NumberAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryMother's InfoMother's Name*First NameLast NameOccupation*Work PhoneArea CodePhone NumberCell Phone*Area CodePhone NumberE-mail*Primary emailFather's InfoFather's Name*First NameLast NameOccupation*Work PhoneArea CodePhone NumberCell PhoneArea CodePhone NumberE-mail*First Camper's InformationChild's Name*First NameMiddle NameLast NameEntering Grade*Birth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGender*MaleFemaleIs the child's father Jewish?*YesNoIs the child's mother Jewish?*YesNoAdditional Camper InformationDoes your child have any known allergies?*YesNoIf yes, please specifyDoes your child have an IEP or other special accommodations?*YesNoGroup Placement: I would like my child placed with (must be entering the same grade)Second Camper's Information:Child's NameFirst NameMiddle NameLast NameEntering GradeBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGenderMaleFemaleAdditional Camper InformationDoes your child have any known allergies?YesNoIf yes, please specifyDoes your child have an IEP or other special accommodations?YesNoGroup Placement: I would like my child placed with (must be entering the same grade)Emergency InformationEmergency Contact 1Emergency Contact 1*First NameLast NameCell Number*Area CodePhone NumberWork Number*Area CodePhone NumberRelationshipEmergency Contact 2Emergency Contact 2First NameLast NameCell NumberArea CodePhone NumberWork NumberArea CodePhone NumberRelationshipPhysician InformationPediatrician/Physician Name*First NameLast NamePhone Number*Area CodePhone NumberAuthorized people to pick up camperPerson 1*First NameLast NamePhone Number*Area CodePhone NumberRelationship*Person 2First NameLast NamePhone NumberArea CodePhone NumberRelationshipPerson 3First NameLast NamePhone NumberArea CodePhone NumberRelationshipChild 1 Swimming AbilityBeginnerIntermediateExpert (can swim in deep end)Child 2 Swimming AbilityBeginnerIntermediateExpert (can swim in deep end)Extended CareEarly care will be available for $30 a session. Early care runs from 8:00 am - 9 am. Aftercare will be available for $30 a session. Aftercare runs from 4pm - 5:30pm.Child 1 - Earlycare needed forSession 1Session 2Session 3Session 4Session 5Session 6Child 1 - Aftercare needed forSession 1Session 2Session 3Session 4Session 5Session 6Child 2 - Earlycare needed forSession 1Session 2Session 3Session 4Session 5Session 6Child 2 - Aftercare needed forSession 1Session 2Session 3Session 4Session 5Session 6Child 1 - LunchSession 1Session 2Session 3Session 4Session 5Session 6Child 2 - LunchSession 1Session 2Session 3Session 4Session 5Session 6T-ShirtsPlease note, for safety of your child, we require that all campers & staff wear a Camp Gan Izzy t-shirt each trip day. While on field trips, camp shirts distinguish our campers and staff from other visitors.T-shirts from previous years are sufficient. Each t-shirt costs $10Child 1 T-shirt size*X-Small (4T)Small (6-8)Medium (10-12)Large (14-16)X-Large (Adult Small)Number of T-shirts*Child 2 T-shirt sizeX-Small (4T)Small (6-8)Medium (10-12)Large (14-16)X-Large (Adult Small)Number of T-shirtsParental InvolvementYes! I would like to get involved!Bunk MotherCamp CommitteeDoes either parent have any special resources or skills to offer our campers or counselors?*YesNoIf Yes, please specifyPermissionI hereby permit my child(ren) to participate in all activities at Camp Gan Izzy – on site, off-site and trips and be transported to and from the field trips and outings. I release Camp Gan Izzy of Colorado and individuals from liability in case of accident during activities related to Camp Gan Izzy of Colorado, as long as normal safety procedures have been taken. I understand that my child(ren) may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision. I am enclosing a minimum registration fee of $50.00 for each child. I understand that the fee is non-refundable.I have read and agree*YesNoI give my child(ren) permission to participate in swimming as scheduled by Camp Gan Izzy of Colorado.*YesNoThe parent who signs the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fee.Parent/Guardian*First NameLast NameDate*MonthDayYear Tuition InformationGan Izzy Division - $225 per session ***Sign up for all 6 sessions and get $100 off for a total of $1250!A $50 non-refundable registration fee per child applies as part of this registration.Child 1- Tuition*Session 1Session 2Session 3Session 4Session 5Session 6All Six SessionsChild 2- TuitionSession 1Session 2Session 3Session 4Session 5Session 6All Six SessionsCamp tuition and t-shirt/lunch/aftercare fees may be paid in full now or paid in installments with a payment plan.Please select:I'd like to pay in fullI'd like to break my payment into 2 autopay installments (the office will contact you shortly)I'd like to break my payment into 4 autopay installments (the office will contact you shortly)ScholarshipsScholarships and payments plans are available. Please contact the office for more information.Sponsor A CamperYes! I would like to enable a less fortunate child to enjoy a summer at Camp Gan Izzy.I am enclosing$225 for 1 week$450 for 2 weeks$1350 for the whole summerI would like to sponsor an alternate amount of:$Payment InformationI agree to pay in full by June 1st. The registration will not be complete until camp tuition and fees are paid in full.Total$0.00PaymentCredit Card Check Credit CardVisaMasterCardDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearI will send in checks made payable to Chabad Jewish CenterGeneral commentsWe are looking forward to a great summer!Should be Empty: Submit This page uses TLS encryption to keep your data secure.