Camp Registration Form - Chabad-Lubavitch of Berks County

Camp Gan Izzy of Berks is a camp dedicated to enriching the lives of children from diverse Jewish backgrounds and affiliations through a stimulating camping experience. Camp Gan Izzy is part of the largest and fastest growing network of day camps, enjoying a reputation as a pioneer in Jewish camping, with innovative ideas and creative abilities, to both provide enjoyment and inspire children to try new and exciting things!
Child/ren Information
Child Name
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Second Child Name
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Third Child Name
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Fourth Child Name
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Parent Info
Father's Name
First NameLast Name
Father's Email
Father's Mobile Number
Area CodePhone Number
Mother's Name
First NameLast Name
Mother's Email
Mother's Mobile Number
Area CodePhone Number

Address

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

PERMISSION TO OBTAIN EMERGENCY MEDICAL TREATMENT
By submitting this form, I give Chabad-Lubavitch of Berks County and its representatives permission to obtain medical treatment for my child(ren) in the event of an emergency. I also agree to indemnify and hold harmless Chabad-Lubavitch of Berks County and its representatives for all costs incurred in any medical treatment or ancillary services for my child.
PERMISSION TO PHOTOGRAPH AND VIDEO
I give Chabad-Lubavitch of Berks County and its representatives permission to photograph and take videos of my child(ren) and use the photos and videos without their name(s) for social media promotion and other purposes.
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Child/ren Information