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Apply

Camp Gan Izzy Application Form
Please fill out the application form below. The camp director will be in touch with you within 3 days to confirm your application.
Dates:
July 5-9, 2021
Please keep your schedule open for the possibility of a Thursday night family BBQ or a Friday night Family Shabbat dinner that week. We will confirm details in June.
Child's Information
Full Name
First NameLast NameAge
Birth Date
MonthDayYear
Grade Entering in September
Hebrew Name
Does your child have any allergies?
What size camp t-shirt should we order?
Would you like to register another child?
YesNo
Child #2 Information
Full Name
First NameLast NameAge
Birth Date
MonthDayYear
Grade Entering in September
Hebrew Name
Does your child have any allergies?
What size camp t-shirt should we order?
Parents' Information
Father
First NameLast Name
Was father born Jewish?
If no, please state if there are any conversions or adoptions
Father's Email
Father's Cell
Area CodePhone Number
Mother
First NameLast Name
Was mother born Jewish?
If no, please state if there were any conversions or adoptions.
Mother's Email
Mother's Cell
Area CodePhone Number

Address

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

Emergency Information
Doctor
First NameLast Name
Phone Number
Area CodePhone Number
Emergency Contact
First NameLast NameRelation to child
Phone Number
Area CodePhone Number
More Information
Permissions*All of these must be selected. If you have a question or hesitation, email Chyena.
I hereby give permission for my child to participate in all Camp Gan Israel activities and tripsI also hereby consent to the administration of Camp Gan Israel to take whatever medical meaures they deem necessary for my child, in the event of a medical EMERGENCY in which they can't reach meI also authorize Camp Gan Israel to have and use photographs, slides and videos of the person named on this application as needed for educational and public relations programsI agree to let Chabad of Grass Valley know immediately if anyone in my family was exposed to COVID during camp or in the 10 days prior.I understand that attending (any) camp can increase my child's risk of contracting covid. I agree to assume full responsibility and not to hold Chabad of Grass Valley or any of its staff responsible whether a COVID19 infection occurs before, during or after participation in Camp Gan Izzy.
What is your main reason for choosing to send your child/ren to Camp Gan Izzy of the Foothills this summer?
Are you interested in more info about early & after care?
Where did you hear about Camp Gan Izzy?
Other comments:
Payment Information
Rates:
Camp Gan Izzy fee: $250 for children ages 6-13
Mini Gan Izzy fee: $200 for children ages 3-5.
Fee includes camp t-shirt, trip admissions, hot lunches and more. Does not include late night trip for the oldest bunk.
Discounts:
$50 off if registered by April 30. Your advance registrations helps us tremendously in planning this summer. Thank you!
Let other Jewish families know about Camp Gan Izzy - $20 Amazon Gift Card for every new family who signs up with your referral.
Camp Tuition
1 Child ages 3-52 Children ages 3-51 Child ages 6-132 Children ages 6-13
I'd like to make a donation to the Camp Scholarship Fund for another child to be able to attend
$0$50$100$200$250
Camp Gan Izzy of the Foothills offers scholarships to families who are unable to pay the full or subsidized tuition. This fund is sponsored by generous people, like you, in our community. Please consider a donation to our Scholarship Fund. If you wish for your donation to go towards a specific child's camp tuition, please indicate that and we will reach out to them without disclosing your name. If you are in need of financial aid, please email [email protected]
Total
$0.00

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Child's Information

Child #2 Information

Parents' Information

Emergency Information

More Information

Payment Information