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Returning Camper Registration

Returning Camper Registration

Returning Camper Registration Form


Please complete one form per camper

Camper Information

Camp Program Attending:

First Name:

Last Name:

Parent's Email:

Grade Entering Fall 2017:


Other Information:

If there have been any changes to your contact information please list them below.


Please select the dates your child will be attending camp, or simply select the total number of weeks you are registering your child if you don't want to specify which weeks at this time. 

Session Attending Pre-Care After Care
1. June 26 - 30
2. July 3 - 7
3. July 10 -14
4. July 17 - 21

 

Total Amount of Weeks Attending (1, 2, 3, or 4):


Medical Consent

Dear Parent/Guardian,

Your son/daughter is below legal age of consent. The law requires that we have your permission if medical service should be needed. Your completion of this consent form will authorize us to proceed with the care of lesser types of medical problems, which may occur. In the event of any major health problems, we will notify you as promptly as possible and follow your instructions. If we are unable to contact you or your alternative contacts listed below, your child will be taken to the nearest Emergency Room Facility and will be treated there.

 

In the event of an emergency when a parent/guardian is unavailable, I hereby authorize a representative of Camp Gan Israel to make such arrangements as considered necessary for my child to receive medical or hospital care, including transportation. Under such circumstances, I further authorize the physician named below (if different than last year, add name and phone number to notes section) to undertake such care and treatment as considered necessary. In the event such physician is not available, I authorize such care and treatment to be performed by any licensed physician or surgeon.

 

Name of Medical Insurance Provider

Medical Insurance Number

I do not choose the above. I desire the following action to be taken in the event of an emergency:



I agree (name) to bear all costs as a result of the foregoing.

As parent/guardian, (name) I agree to the terms above.

Please provide any allergy or other medical information we should know.

MAIN CAMP
TRIP RELEASE
FORM

 


I agree (name) to allow my child to participate in all off-campus activities, trips, activities (where applicable).

IMAGES
CGI Cobb and Chabad of Cobb are hereby granted permission to use any individual or group camp photos and or videos showing our children involved in camp activities.


PAYMENT OPTIONS (For rates click here)

Terms of agreement: (please check one)

Payment Method

Check Credit Card

Payment Plan: (All payments due before camp begins)

Full Payment  

   4 equal consecutive monthly payments (for registration received by March 1, 2017)

  3 equal consecutive monthly payments (for registration received by April 1, 2017)

2 equal consecutive monthly payments (for registration received by May 1, 2017)

Credit Card Information
Visa MC Amex Number


Exp. Date (month/year)


CVV Security

Name on Card (please print)

Street Address and Zip Code where the bill is sent


Enrollment Agreement

I agree to the terms of enrollment and information listed above.
My name (Parent or Legal Guardian)

 

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