Please note: Registration is pending approval from camp Parent information Home Phone Number* Area Code Phone Number Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Mother's Info Mother's Name* First Name Last Name Occupation* Work Phone Area Code Phone Number Cell Phone* Area Code Phone Number E-mail* Primary email Father's Info Father's Name* First Name Last Name Occupation* Work Phone Area Code Phone Number Cell Phone* Area Code Phone Number E-mail* First Camper's Information Child's Name* First Name Middle Name Last Name Entering Grade* Birth Date* 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 Gender* Male Female Name of school attended in 22-23 Is the child's father Jewish?* Yes No Is the child's mother Jewish?* Yes No Additional Camper Information Does your child have any known allergies?* Yes No If yes, please specify Does your child have an IEP or other special accommodations?* Yes No Group Placement: I would like my child placed with (must be entering the same grade) Second Camper's Information: Child's Name First Name Middle Name Last Name Entering Grade Birth Date 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 Gender Male Female Name of school attended in 22-23 Additional Camper Information Does your child have any known allergies? Yes No If yes, please specify Does your child have an IEP or other special accommodations? Yes No Group Placement: I would like my child placed with (must be entering the same grade) Emergency Information In the unlikely event of an emergency, we will first reach out to our camper's parents. Please fill out 1-2 emergency contacts for us to contact if the parents are unavailable. Emergency Contact 1 Emergency Contact 1* First Name Last Name Cell Number* Area Code Phone Number Work Number* Area Code Phone Number Relationship Emergency Contact 2 Emergency Contact 2 First Name Last Name Cell Number Area Code Phone Number Work Number Area Code Phone Number Relationship Physician Information Pediatrician/Physician Name* First Name Last Name Phone Number* Area Code Phone Number Authorized people to pick up camper If 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 1 First Name Last Name Phone Number Area Code Phone Number Relationship Person 2 First Name Last Name Phone Number Area Code Phone Number Relationship Person 3 First Name Last Name Phone Number Area Code Phone Number Relationship Swimming Ability Child 1 Swimming Ability Beginner Intermediate Expert (can swim in deep end) Child 2 Swimming Ability Beginner Intermediate Expert (can swim in deep end) Extended Care Early 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 for Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Child 1 - Aftercare needed for Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Child 2 - Earlycare needed for Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Child 2 - Aftercare needed for Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Lunch A kosher hot lunch will be available for $40 a session. Child 1 - Lunch Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Child 2 - Lunch Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 T-Shirts Please 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 $10 Child 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 size X-Small (4T) Small (6-8) Medium (10-12) Large (14-16) X-Large (Adult Small) Number of T-shirts Parental Involvement Does either parent have any special resources or skills to offer our campers or counselors?* Yes No If Yes, please specify Permission I 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* Yes No I give my child(ren) permission to participate in swimming as scheduled by Camp Gan Izzy of Colorado.* Yes No The 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 Name Last Name Date* Month Day Year Tuition Information Pioneer 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 1 Session 2 Session 3 Session 4 Session 5 Session 6 All Six Sessions Child 2- Tuition Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 All Six Sessions Scholarships Scholarships and payments plans are available. Please contact the office for more information. Sponsor A Camper Yes! 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 summer I would like to sponsor an alternate amount of: $ Payment Information You 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. Total $0.00 Pay in full now via credit card Credit Card Payment plan Credit Card We accept Visa, MasterCard, 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 Please have the office contact me to set up a monthly payment plan Referred by/comments We are looking forward to a great summer! Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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