Register Online Summer 2011 | Camp Gan Israel of North Potomac

Payment Form

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High Holiday Fair! Sun. Sept. 5 Click here for info

Summer Camp 2011 Online Registration Form

Please fill out the form below carefully. When you press submit, this form will be sent to our
administrative office.

New! Click here for Camp 2010 Brochure

Click here for Camp 2010 Promo Brochure

Click here for Cancellation policy

Note: Please use a separate form for each child.

Camper Information
Name of Camper		Last	First	Hebrew	gender Male Female
Address		Street	City	State	Zip
Date of Birth
School and Grade Entering		school	grade entering Fall '11
Synagogue affiliation
Home Phone & Email		Phone	Email
Parents' Names		Father	Mother

Please indicate which sessions your child will be attending camp:
Session 1; June 27 - July 8 Session 2; July 11 - 22 Session 3; July 25 - August 5 Bonus Week: August 8 - 12 Requires attendance of at least one regular session. Kiddie Kamp Half Day Program for 3 & 4 year olds Full Day Program for 3 & 4 year olds Check here for Half Day Kiddie Kamp Art & Enrichment Program Click here for information regarding this program
Transportation & Extended Care: Please check if you will be needing transportation and/or extended care. Note that there are extra charges for these services. Also, if you sign up for extended care, you must sign up for and pay for transportation.
	EXTENDED CARE: AM PM We will contact you with further information. TRANSPORTATION: AM Pick-up PM Drop-off Transportation subject to availability.
		Comments
IMPORTANT
•	All forms must be completed and submitted before your child begins camp.
•	I will be paying by: check credit card already on file credit card (Visa, Mastercard, AmEx, or Discover) Click here for our secure payment form.
•	I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency. By signing below, you agree to this policy.
	Parent Signature:
	Date of Application:

Camp Gan Israel of North Potomac • 11520 Darnestown Road • Gaithersburg, MD 20878 • 301-926-3632
A branch of the world's largest Jewish Camping network, Camp Gan Israel International