Camp Gan Izzy Registration

Father's Name*

First Name Last Name

Father's Email*

Father's Phone Number*

Area Code Phone Number

Is the Father Jewish?*

Mother's Name*

First Name Last Name

Mother's Email*

Mother's Phone Number*

Area Code Phone Number

Is the Mother Jewish?*

Child's Primary Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status of Parents*

Any conversions in the family?*

If so, please explain:*

How many children are you registering?*

Child #1 legal name*

Child #1 Hebrew name if known

Child #1 Date of Birth*

Month Day Year

Please indicate time of birth as:* this helps determine the Hebrew birthday

School child #1 is attending in the fall:*

Grade child #1 is entering in the fall:*

Is child #1 adopted?*

List any medications Child #1 takes:* enter N/A if not applicable

List any allergies Child #1 has to food or medications:* enter N/A if not applicable

Does child #1 need an epi-pen?*

Does child #1 have any medical, developmental or behavioral issue that we should know about?*

If so, please explain:*

Which weeks of camp will child #1 be attending?* Choose all that apply

June 29 - July 4July 6 - July 10July 13 - July 17July 20 - July 24

Does child #1 need Camp Gan Izzy Early/After Care?*

Which weeks of camp will child #1 be needing Early/After Care?* Choose all that apply

June 29 - July 4 - 8:00am - 9:00amJune 29 - July 4 - 3:00pm - 4:00pmJuly 6 - July 10 - 8:00am - 9:00amJuly 6 - July 10 - 3:00pm - 4:00pmJuly 13 - July 17 - 8:00am - 9:00amJuly 13 - July 17 - 3:00pm - 4:00pmJuly 20 - July 24 - 8:00am - 9:00amJuly 20 - July 24 - 3:00pm - 4:00pm

Child #2 legal name*

Child #2 Hebrew name if known

Child #2 Date of Birth*

Month Day Year

Please indicate time of birth as:* this helps determine the Hebrew birthday

School child #2 is attending in the fall:*

Grade child #2 is entering in the fall:*

Is child #2 adopted?*

List any medications Child #2 takes:* enter N/A if not applicable

List any allergies Child #2 has to food or medications:* enter N/A if not applicable

Does child #2 need an epi-pen?*

Does child #2 have any medical, developmental or behavioral issue that we should know about?*

If so, please explain:*

Which weeks of camp will child #2 be attending?* Choose all that apply

June 29 - July 4July 6 - July 10July 13 - July 17July 20 - July 24

Does child #2 need Camp Gan Izzy Early/After Care?*

Which weeks of camp will child #2 be needing Early/After Care?* Choose all that apply

June 29 - July 4 - 8:00am - 9:00amJune 29 - July 4 - 3:00pm - 4:00pmJuly 6 - July 10 - 8:00am - 9:00amJuly 6 - July 10 - 3:00pm - 4:00pmJuly 13 - July 17 - 8:00am - 9:00amJuly 13 - July 17 - 3:00pm - 4:00pmJuly 20 - July 24 - 8:00am - 9:00amJuly 20 - July 24 - 3:00pm - 4:00pm

Child #3 legal name*

Child #3 Hebrew name if known

Child #3 Date of Birth*

Month Day Year

Please indicate time of birth as:* this helps determine the Hebrew birthday

School child #3 is attending in the fall:*

Grade child #3 is entering in the fall:*

Is child #3 adopted?*

List any medications Child #3 takes:* enter N/A if not applicable

List any allergies Child #3 has to food or medications:* enter N/A if not applicable

Does child #3 need an epi-pen?*

Does child #3 have any medical, developmental or behavioral issue that we should know about?*

If so, please explain:*

Which weeks of camp will child #3 be attending?* Choose all that apply

June 29 - July 4July 6 - July 10July 13 - July 17July 20 - July 24

Does child #3 need Camp Gan Izzy Early/After Care?*

Which weeks of camp will child #3 be needing Early/After Care?* Choose all that apply

June 29 - July 4 - 8:00am - 9:00amJune 29 - July 4 - 3:00pm - 4:00pmJuly 6 - July 10 - 8:00am - 9:00amJuly 6 - July 10 - 3:00pm - 4:00pmJuly 13 - July 17 - 8:00am - 9:00amJuly 13 - July 17 - 3:00pm - 4:00pmJuly 20 - July 24 - 8:00am - 9:00amJuly 20 - July 24 - 3:00pm - 4:00pm

Child #4 legal name*

Child #4 Hebrew name if known

Child #4 Date of Birth*

Month Day Year

Please indicate time of birth as:* this helps determine the Hebrew birthday

School child #4 is attending in the fall:*

Grade child #4 is entering in the fall:*

Is child #4 adopted?*

List any medications Child #4 takes:* enter N/A if not applicable

List any allergies Child #4 has to food or medications:* enter N/A if not applicable

Does child #4 need an epi-pen?*

Does child #4 have any medical, developmental or behavioral issue that we should know about?*

If so, please explain:*

Which weeks of camp will child #4 be attending?* Choose all that apply

June 29 - July 4July 6 - July 10July 13 - July 17July 20 - July 24

Does child #4 need Camp Gan Izzy Early/After Care?*

Which weeks of camp will child #4 be needing Early/After Care?* Choose all that apply

June 29 - July 4 - 8:00am - 9:00amJune 29 - July 4 - 3:00pm - 4:00pmJuly 6 - July 10 - 8:00am - 9:00amJuly 6 - July 10 - 3:00pm - 4:00pmJuly 13 - July 17 - 8:00am - 9:00amJuly 13 - July 17 - 3:00pm - 4:00pmJuly 20 - July 24 - 8:00am - 9:00amJuly 20 - July 24 - 3:00pm - 4:00pm

List name(s) of those, other than parents, who are authorized to pick up your child(ren) from school:

Summer 2026 Rates:

Non-refundable Registration and Security Fee:
$100 per child.

Camp Tuition:
$350 per week (includes breakfast and lunch)

Camp Early and After Care:
8:00am - 9:00am - $50 per week, per child
3:00pm - 4:00pm - $50 per week, per child

Sibling Discount*
Families registering more than one child will receive 10% off tuition for the second sibling.

Once accepted into camp, tuition will be collected in 2 payments (unless "payment in full" is selected):
Payment #1 - Day of acceptance
Payment #2 - June 1st

*Sibling discount will be applied after completing this form

Payment options:*

Camp Gan Izzy T-Shirts $12 each:* Campers are required to wear these on big trips.

Total Deposit + Tuition (tuition payment will not be processed until registration is confirmed)

$0.00

Payment*

⚠ You have not yet connected a credit card processor.

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Is the billing address the same as listed above?*

Billing Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Questions or comments regarding payment:

To enroll your child(ren) in Chabad West Boca – Camp Gan Izzy, all required forms must be submitted together with the applicable fees.

Enrollment is considered to be for the entire camp session for which the child is registered. The camp cannot issue refunds or credits for absences due to illness, holidays, family vacations, or early withdrawal. In the event that the camp is closed due to a weather emergency, public health directive, or other unforeseen circumstances, there will be no make-up days, refunds, or credits for days that camp is not in session.

If a tuition payment is processed and sufficient funds are not available, or a credit card payment is declined, a $25 processing fee will be charged to your account for each transaction that cannot be completed.

Parent(s) acknowledge that Camp Gan Izzy serves children who are able to function successfully in a group setting. If, in the judgement of the Camp's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is requested to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.

We give permission for the use of photographs of our child(ren) in print materials, on our website, social media and/or emails. Last names of children are never listed.

We give permission for our name and telephone number(s) to be included in any class list that may be distributed.

I hereby give permission, in the event of an emergency, for the Director, Acting Director, or the Staff at Camp Gan Izzy to take whatever steps may be necessary for the medical care of my child. I understand that in order for Camp Gan Izzy to assume responsibility for my child, I, or the person(s) whom I have designated to drop off and pick up my child, must sign my child in at the time of arrival and out at the time of departure. I understand that unless there is a need for immediate action, the order of the steps taken will follow, but will not be limited to, the outline below:

1. The parent/guardian will be called. Note: If the parent/guardian is unavailable, the emergency contact person designated by the parent/guardian will be called.

2. If these efforts are unsuccessful the following steps will be taken (order may vary depending on the situation):

a. A physician will be called.

b. The child will be taken to the nearest emergency room accompanied by a staff member.

c. An ambulance will be called to take the child to the nearest emergency room accompanied by a staff member.

In the event of an emergency, if I cannot be reached, I give consent for a Camp staff member to transport my child to the nearest emergency facility, or to have my child transported by ambulance. I give consent to any emergency facility and physician to administer any necessary medical treatment to my child as the situation may warrant it.

Emergency Contact Name*

First Name Last Name

Emergency Contact Cell Phone*

Area Code Phone Number

If parents cannot be reached and emergency medical advice is needed, permission is given to Camp Gan Izzy staff to phone my child's doctor.

In case of a medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital, if necessary. It is understood that I will hold Camp Gan Izzy harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff.

I have provided information, consent, authorization and agreement where indicated, and the information I provided is accurate.

Type first and last name of parent completing this form, to be used as your electronic signature.*

First Name Last Name

Please send a confirmation email to:*

Camper Registration

Family Info

Child Information

Child #1

Child #2

Child #3

Child #4

Pick-up Authorization

Payment info

Enrollment Agreement

Medical Emergencies

Parent Electronic Signature

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