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CIT Trip to LA Register Form

CIT Trip to LA Register Form

  • This year we will be teaming of with Camp Gan Israel Silicon Valley for their annual CIT trip to LA this trip is open for CIT and Junior Counselors entering 7-9th grades.

    July 17-August 20 2017/ 4 days 3 Nights.

    The famous LA trip is the highlight of the CIT program. The four-day trip features Disneyland, and Magic Mountain.

    The CITs will stay in comfortable accommodations and dine at Kosher Restaurants in Los Angeles.

    Complete details including trip itinerary, accommodations and packing list will be sent out before the trip.

    For a Sample Schedule please click Here

  • 1. Camper Information

  • 2. Parent information

  • 3. Emergency Information

  • 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.

  • 4. Payment Information

  • $0.00
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    Credit Card
    Please send your check to Chabad of Contra Costa 1671 Newell Ave. Walnut Creek, CA 94595.
    Billing Address
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