Camp Registration Form (Payment) - Chabad Lubavitch of Greater Daytona

Welcome to CGI Daytona.
If this is your first time joining our camp, please fill out the new family initial form HERE prior to registering.
Registration deadlines:
Week 1: June 15
Week 2: July 2
Week 3: July 9
Week 4: July 16
Registrations received after each deadline will be enrolled in the next available week(s).
PARENT INFORMATION
Father's Name*
First Name Last Name
Father's Phone Number*

Area Code Phone Number
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Phone Number*

Area Code Phone Number
Mother's E-mail*
I would like to receive news and updates by email
Emergency Contact (other than parents)*
Please list any of your children that have permission to wallk home. (2nd grade and higher):*
Persons that have permission to pick up your child/children (other than parents):*
I give Camp Gan Israel permission to photograph and/or videotape my child/children while participating in events/activities hosted by Camp Gan Israel of Greater Daytona.*

YesNo
E-signature:*
CAMPER INFORMATION
How many campers will you be registering this summer?*
(Registration Fee $150 Per Camper)
CAMPER # 1
Name*
First Name Last Name
Gender*

BoyGirl
Age*
Birth Date*

Month Day Year
Current Grade*
What part of camp will camper #1 be attending?*
Click HERE for Mini Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Regular Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Pioneers forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
How many weeks will you be attending?*
($340 per week)
How many weeks will you be attending?*
($430 per week)
Weeks attending*

Week 1Week 2Week 3Week 4
How many T-shirts would you like to order for camper #1?*
($15 per T-shirt)
Please select T-shirt size and style*
Does your child swim?*

YesNo, not allowed in waterYes, with flotation assistance
Swim Level: List most recent American Red Cross child earned, date and place.*
CAMPER # 1 MEDICAL INFORMATION
Date of last health examination:*

Month Day Year
I give permission for camp staff to administer the following over-the-counter medication(s) to my child as needed. I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonable prudent person should have acted under the same or similar circumstances.
Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child/children while attending camp?*

YesNo
Please select permitted medications*

TylenolAdvilBenadrylHydro Cortisone CreamI allow camp to apply sunscreenAll the aboveNone of the above
Does your child have any social, emotional or physical needs that we should be made aware of?*
Does your child take medication regularly? if so, what kind?*
Does your child have any allergies?*

YesNo
List any known allergies:*
How severe is your child's reaction?*

MildModerateSevereNone
What treatment is required for reaction?*
Name, Address and phone number of Doctor:*
CAMPER # 2
Name*
First Name Last Name
Gender*

BoyGirl
Age*
Birth Date*

Month Day Year
Current Grade*
What part of camp will camper #2 be attending?*
Click HERE for Mini Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Regular Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Pioneers forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
How many weeks will you be attending?*
($340 per week)
How many weeks will you be attending?*
($430 per week)
Weeks attending*

Week 1Week 2Week 3Week 4
How many T-shirts would you like to order for camper #2?*
($15 per T-shirt)
Please select T-shirt size and style*
Does your child swim?*

YesNo, not allowed in waterYes, with flotation assistance
Swim Level: List most recent American Red Cross child earned, date and place.*
CAMPER # 2 MEDICAL INFORMATION
Date of last health examination:*

Month Day Year
I give permission for camp staff to administer the following over-the-counter medication(s) to my child as needed. I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonable prudent person should have acted under the same or similar circumstances.
Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child/children while attending camp?*

YesNo
Please select permitted medications*

TylenolAdvilBenadrylHydro Cortisone CreamI allow camp to apply sunscreenAll the aboveNone of the above
Does your child have any social, emotional or physical needs that we should be made aware of?*
Does your child take medication regularly? if so, what kind?*
Does your child have any allergies?*

YesNo
List any known allergies:*
How severe is your child's reaction?*

MildModerateSevereNone
What treatment is required for reaction?*
Name, Address and phone number of Doctor:*
CAMPER # 3
Name*
First Name Last Name
Gender*

BoyGirl
Age*
Birth Date*

Month Day Year
Current Grade*
What part of camp will camper #3 be attending?*
Click HERE for Mini Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Regular Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Pioneers forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
How many weeks will you be attending?*
($340 per week)
How many weeks will you be attending?*
($430 per week)
Weeks attending*

Week 1Week 2Week 3Week 4
How many T-shirts would you like to order for camper #3?*
($15 per T-shirt)
Please select T-shirt size and style*
Does your child swim?*

YesNo, not allowed in waterYes, with flotation assistance
Swim Level: List most recent American Red Cross child earned, date and place.*
CAMPER # 3 MEDICAL INFORMATION
Date of last health examination:*

Month Day Year
I give permission for camp staff to administer the following over-the-counter medication(s) to my child as needed. I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonable prudent person should have acted under the same or similar circumstances.
Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child/children while attending camp?*

YesNo
Please select permitted medications*

TylenolAdvilBenadrylHydro Cortisone CreamI allow camp to apply sunscreenAll the aboveNone of the above
Does your child have any social, emotional or physical needs that we should be made aware of?*
Does your child take medication regularly? if so, what kind?*
Does your child have any allergies?*

YesNo
List any known allergies:*
How severe is your child's reaction?*

MildModerateSevereNone
What treatment is required for reaction?*
Name, Address and phone number of Doctor:*
CAMPER # 4
Name*
First Name Last Name
Gender*

BoyGirl
Age*
Birth Date*

Month Day Year
Current Grade*
What part of camp will camper #4 be attending?
Click HERE for Mini Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Regular Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Pioneers forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
How many weeks will you be attending?*
($340 per week)
How many weeks will you be attending?*
($430 per week)
Weeks attending*

Week 1Week 2Week 3Week 4
How many T-shirts would you like to order for camper #4?*
($15 per T-shirt)
Please select T-shirt size and style*
Does your child swim?*

YesNo, not allowed in waterYes, with flotation assistance
Swim Level: List most recent American Red Cross child earned, date and place.*
CAMPER # 4 MEDICAL INFORMATION
Date of last health examination:*

Month Day Year
I give permission for camp staff to administer the following over-the-counter medication(s) to my child as needed. I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonable prudent person should have acted under the same or similar circumstances.
Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child/children while attending camp?*

YesNo
Please select permitted medications*

TylenolAdvilBenadrylHydro Cortisone CreamI allow camp to apply sunscreenAll the aboveNone of the above
Does your child have any social, emotional or physical needs that we should be made aware of?*
Does your child take medication regularly? if so, what kind?*
Does your child have any allergies?*

YesNo
List any known allergies:*
How severe is your child's reaction?*

MildModerateSevereNone
What treatment is required for reaction?*
Name, Address and phone number of Doctor:*
CAMPER # 5
Name*
First Name Last Name
Gender*

BoyGirl
Age*
Birth Date*

Month Day Year
Current Grade*
What part of camp will camper #5 be attending?*
Click HERE for Mini Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Regular Gan forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
Click HERE for Pioneers forms and waivers. In order for your camp registration to be complete, all camp forms and waivers must be printed, filled out, and brought to the office.
How many weeks will you be attending?*
($340 per week)
How many weeks will you be attending?*
($430 per week)
Weeks attending*

Week 1Week 2Week 3Week 4
How many T-shirts would you like to order for camper #5?*
($15 per T-shirt)
Please select T-shirt size and style*
Does your child swim?*

YesNo, not allowed in waterYes, with flotation assistance
Swim Level: List most recent American Red Cross child earned, date and place.*
CAMPER # 5 MEDICAL INFORMATION
Date of last health examination:*

Month Day Year
I give permission for camp staff to administer the following over-the-counter medication(s) to my child as needed. I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonable prudent person should have acted under the same or similar circumstances.
Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child/children while attending camp?*

YesNo
Please select permitted medications*

TylenolAdvilBenadrylHydro Cortisone CreamI allow camp to apply sunscreenAll the aboveNone of the above
Does your child have any social, emotional or physical needs that we should be made aware of?*
Does your child take medication regularly? if so, what kind?*
Does your child have any allergies?*

YesNo
List any known allergies:*
How severe is your child's reaction?*

MildModerateSevereNone
What treatment is required for reaction?*
Name, Address and phone number of Doctor:*
PAYMENT INFORMATION
*Amount to be charged upon submission

$0.00

Payment*

Credit Card Check, Cash, In the Office

Postal / Zip Code

Country

I acknowledge that in order to receive early bird savings, all documents must be in the office by May 1st. Otherwise, I will be charged the regular price and a $150 registration fee per camper.*
Click HERE to read the Camp Information Packet
Did you read the camp information packet and print out ALL forms and waivers?*

YesNo
Please acknowledge HERE that you read the camp information packet and printed all forms and waivers to enable the submit button. Click HERE for all forms and waivers.
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