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Please fill out 1-2 emergency contacts for us to contact if the parents are unavailable.Emergency 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 camperIf someone OTHER than a camper's parent will be picking them up from camp, they need to be authorized below, for the camper to be permitted to go with them.Person 1First NameLast NamePhone NumberArea CodePhone NumberRelationshipPerson 2First NameLast NamePhone NumberArea CodePhone NumberRelationshipPerson 3First NameLast NamePhone NumberArea CodePhone NumberRelationshipSwimming AbilityChild 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 6LunchA kosher hot lunch will be available for $30 a session.Child 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 InformationPioneer Division - $275 per session ***Sign up for all 6 sessions and save $100 for a total of $1550!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 SessionsScholarshipsScholarships 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$275 for 1 week$550 for 2 weeks$1550 for the whole summerI would like to sponsor an alternate amount of:$Payment InformationYou may pay camp tuition in full now or else set up a payment plan with our office.Your child's registration fees are due in full by June 1st.I agree to pay in full by June 1st.The registration will not be complete until camp tuition and fees are paid in full.Total$0.00Pay in full now via credit card, or set up a payment plan (our office will contact you shortly)Credit Card Set up installment plan with office Credit CardVisaMasterCardDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2021202220232024202520262027202820292030Expiration YearPlease note: Your child's spot is not reserved until the initial installment has been received.Referred by/commentsWe are looking forward to a great summer!Should be Empty: Submit This page uses TLS encryption to keep your data secure.