A $100 non-refundable deposit per child is due in order to reserve a spot for your child. This amount will be applied to your final tuition cost. Your application cannot be accepted without this deposit. Full tuition is due by June 2nd and is non-refundable after this time. Camper Information Camper Full Name* First Name Last Name Camper Hebrew Name* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Current Age* Current School* Grade Entering as of August 2024* Preschool 4sPreschool 5sKindergarten1234567 Gender* FemaleMale T-shirt Size* Camp T-shirts must be worn on all trip days. One camp t-shirt is included with your camp fee. Additional t-shirts are available at $10/t-shirt. X-Small (2-4)Small (6-8)Medium (10-12)Large (14-16)X-Large (18-20)Adult SAdult M Which week/s would you like to register for?* Full Session (July 15-26)Week 1 (July 15-19)Week 2 (July 22-26)Lunch Program (Week 1)Lunch Program (Week 2) Do you need extended care? Week 1 Early Care (July 15-19)Week 1 Extended Care (July 15-19)Week 2 Early Care (July 22-26)Week 2 Extended Care (July 22-26) Does your child have any allergies or dietary restrictions? If yes, Please explain.* Does your child have any health issues that we need to know about? If yes, Please explain.* Are you registering another camper?* YesNo Camper 2 Information Camper Full Name* First Name Last Name Camper Hebrew Name* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Current Age* Current School* Grade Entering as of August 2024* Preschool 4sPreschool 5sKindergarten1234567 Gender* FemaleMale T-shirt Size* Camp T-shirts must be worn on all trip days. One camp t-shirt is included with your camp fee. Additional t-shirts are available at $10/t-shirt. X-Small (2-4)Small (6-8)Medium (10-12)Large (14-16)X-Large (18-20)Adult SAdult M Which week/s would you like to register for?* Full Session (July 15-26)Week 1 (July 15-19)Week 2 (July 22-26)Lunch Program (Week 1)Lunch Program (Week 2) Do you need extended care? Week 1 Early Care (July 15-19)Week 1 Extended Care (July 15-19)Week 2 Early Care (July 22-26)Week 2 Extended Care (July 22-26) Does your child have any allergies or dietary restrictions? If yes, Please explain.* Does your child have any health issues that we need to know about? If yes, Please explain.* Are you registering another camper?* YesNo Camper 3 Information Camper Full Name* First Name Last Name Camper Hebrew Name* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Current Age* Current School* Grade Entering as of August 2024* Preschool 4sPreschool 5sKindergarten1234567 Gender* FemaleMale T-shirt Size* Camp T-shirts must be worn on all trip days. One camp t-shirt is included with your camp fee. Additional t-shirts are available at $10/t-shirt. X-Small (2-4)Small (6-8)Medium (10-12)Large (14-16)X-Large (18-20)Adult SAdult M Which week/s would you like to register for?* Full Session (July 15-26)Week 1 (July 15-19)Week 2 (July 22-26)Lunch Program (Week 1)Lunch Program (Week 2) Do you need extended care? Week 1 Early Care (July 15-19)Week 1 Extended Care (July 15-19)Week 2 Early Care (July 22-26)Week 2 Extended Care (July 22-26) Does your child have any allergies or dietary restrictions? If yes, Please explain.* Does your child have any health issues that we need to know about? If yes, Please explain.* Family Information Address* Street Address Street Address Line 2 City State / Province Postal / 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 SaharaYemenZambiaZimbabweOther Country Phone Number* E-mail* Parent 1 Name* First Name Last Name Parent 1 Mobile Number* Parent 2 Name* First Name Last Name Parent 2 Mobile Number:* Is Parent 1 Jewish?* Is Parent 2 Jewish?* Medical/Emergency Information Pediatrician* Pediatrician Phone Number* In case of emergency and we are unable to contact a parent, please write an individual that can be contacted. Emergency Contact* Emergency Contact Phone Number* Emergency Contact Relationship to Child* Payment Information Total $0.00 Payment* Credit Card Paypal Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPaypal has been selected. Payment will take place on the next page.Billing Address Street Address City State / Province Postal / 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 SaharaYemenZambiaZimbabweOther Country As the parent(s) or legal guardian(s) of child noted above, I/we authorize any adult acting on behalf of the Camp Gan Israel of Greenville/Chabad of Greenville, to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, the camp will try to communicate with me prior to such treatment. As parents/guardians, we agree that we will be responsible for any loss, damage or destruction by our camper to any property of Camp Gan Israel or to any property for which the camp is liable or chargeable. I/we hereby give permission for my child to attend all field trips and outings sponsored by the Camp Gan Israel of Greenville/Chabad of Greenville and be transported to and from the field trips and outings. I also allow my child to be photographed/videod while participating in camp activities. I/we understand that these photographs/videos may be used for publicity purposes. Please date and sign. Please type your signature here* Today's Date* Month Day Year Comments I would like to receive news and updates from Chabad of Greenville by email. 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