Online Registration - Chabad at Stony Brook
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CAMP GAN ISRAEL 2017

Caring & dedicated staff! Fun games & activities! Water & outdoor play! Crafts & art! Gan Izzy spirit!

AGES: 3 - 8 

LOCATION: 821 Hawkins Ave, Lake Grove 

DATES: June 26 - July 28

TIMES: Mon - Thurs: 9:30am - 3:30pm, Fri: 9:30am - 2:00pm

RATES: $200 per week

Please complete the form below carefully. This form is good for up to 3 children. 

Space is reserved once deposit is received.   

1. Camper's Name:
  Hebrew Name
  Nickname
  Gender & DOB M F
  Grade
  New/Returning New Camper  Returning Camper
    Any special concerns/allergies/requests regarding camper?

 

2. Camper's Name:
  Hebrew Name
  Nickname
 
Gender & DOB M F
  Grade
  New/Returning New Camper   Returning Camper
    Any special concerns/allergies/requests regarding camper?

 

3. Camper's Name:
  Hebrew Name
  Nickname
 
Gender & DOB M F
  Grade
  New/Returning New Camper Returning Camper
    Any special concerns/allergies/requests regarding camper?

 

Family Information
  Mother's Name
  Mother's Cell
  Mother's Work
  Father's Name
  Father's Cell
  Father's Work
 
Street Address
  City/State/Zip
  Home
  E-mail
  Referred by
 

Discount

Additional Comments or Requests 

 

 

Important Information
 

Balance is due by June 26, 2017.  In the event full payment is not received by June 26, your credit card will be charged for the balance of the fee.  There is a 3% charge added for credit card payments.

  I have read the camp's terms and conditions and agree to the terms and conditions stated.
 
Payment Information
  Name on Card
  Card #
  Card Type/Exp. Date
  CVV Number
  Payment Terms Charge my card the full amount (3% cc charge will be waved)
Charge my card half the amount today, and the second half in one month from today.

 

 

 

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