Register Online Summer 2012 | Camp Gan Israel of North Potomac

	Register Online Summer 2012
	Payment Form

What a Summer! Watch the Video @ YouTube.com/watch?v=lFg1xETAiBY

Summer Camp 2012 Online Registration Form

Register on or before December 30 and receive a Chanukah discount.
$100 discount for full summer registration [3 sessions] or $30 discount per session.
Enter coupon code CHANUKAH in the coupon box on the registration form.

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

There is a $100 non-refundable deposit required with each child's registration form. We must receive both the completed registration form and the deposit before we can begin the registration process for your child.

Click here for the Camp 2011 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		Month	Date	Year
School & Grade Entering		school	grade entering Fall '12
Synagogue affiliation
Home Phone & Email		Phone	Email
Parents' Names		Father	Mother

Please indicate which sessions your child will be attending camp:
Session 1; June 25 - July 6 Session 2; July 9 - 20 Session 3; July 23 - August 3 If Registering for Kiddie Kamp, Please Select Program: Half Day Program for 3 & 4 year olds Full Day Program for 3 & 4 year olds All campers must be toilet trained before the start of camp.
Transportation & Extended Care: Please check if you will be needing transportation and/or extended care. Note that there are extra charges for these services. 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.
•	A $100 non-refundable deposit is due with this registration. I will be paying this by: check credit card already on file credit card (Visa, Mastercard, AmEx, or Discover) Click here for our secure payment form.
•	Coupon code:
•	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