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Registration 2017

Registration 2017

  • CGI Registration 2017

    We are currently accepting registration forms for the summer 2017. Please fill out the necessary fields of this form. If you have any questions or concerns you'd like to discuss with us, please Email Chaya@JewishContraCosta.com. Registration is complete when our office receives the registration fee of $100 Per Camper. The registration fee is deducted from the tuition and is not refundable.We look forward to a wonderful summer.
  • Camper Information

    Camper 1
  • Camper 2- Skip this Section if not necessary.
  • Camper 3- Skip this Section if not necessary
  • Parents' Information

  • Emergency Contact Information

  • Additional authorized persons to pick up my child:

  • CONFIDENTIAL: Does you child have any allergies or other medical conditions that we should be aware of?  If yes, please describe them and indicate special precautions or care needed.

  • In case of an accident or serious illness involving my child whenever the child is in attendance at Camp Gan Israel, I request The Camp to telephone me at the above listed telephone. If in the judgment of The Camp, delay entailed in telephoning me or other persons named above would not be in the best interest of my child, I hereby authorize The Camp before telephoning me to take my child to any physician or surgeon selected by The Camp and licensed under the provision of the California Medical Practice Act, to any physician or surgeon selected by the director for such action as such physician or surgeon deems necessary or advisable in the circumstances. I hereby consent to any and all diagnostic procedures, examinations, care and treatment (including without limitation, X-ray examination, anesthetic and emergency surgical intervention) as any such physician or surgeon may deem necessary or advisable, whether such diagnostic procedure, examination, care or treatment is rendered at the office of such physician, surgeon or dentist or at a hospital or clinic. I understand that this authorization is given in advance of any specific diagnosis, examination, care or treatment being rendered and is given to provide authority and power on the part of any such physician or surgeon to render any and all such diagnostic procedures, examinations, care or treatment that he or she may deem necessary or advisable. I certify that no information concerning the health of this counselor/camper has been withheld or misrepresented. I authorize our physician to provide further medical history should it be deemed necessary. This completed form may be photocopied for trips out of camp. I hereby give permission, for my child registered in any of the Monday – Friday programs of Camp Gan Israel, to be taken by school bus on all outings and trips. I give permission to Camp Gan Israel to use camp photos of my child/ren in any camp publicity. I understand that refund of payment is subject to Camp Gan Israel refund policies, as written in the parent handbook.

  • Fees & Payment

  • Discounts
    Sibling Discount: $10.00 per week off additional child/ren fees. 
    Early Bird Discount: 25.00 per child.  Early bird discount cut off date: March 31, 2017 (Minimum 2 week enrollment) 

    New Family Referral: $25.00

    I would like to make a tax deductible contribution to the Camp Gan Israel Scholarship Fund in the amount of  . For more information about the Camp Gan Israel Scholarship Fund please click here .

    Please make all checks out to Chabad of Contra Costa and mail to Chabad of Contra Costa 1671 Newell Ave. Walnut Creek, CA 94595.

    Registration complete when our office receives non refundable  registration fee.

  • $0.00

    I would like to pay today:
  •   
    Credit Card
    I will send a check for the registration fee of $100.00 and I will pay the remaining balance by May 25.
    Billing Address
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