Camp Gan Izzy Registration

FAMILY INFORMATION

If child or children are living with guardians other than the parents, please use the guardian's information and note this in the comments section.
Mother's Full Name*
First Name Last Name

Address*

Phone Number*
E-mail*
I would like to receive news and updates by email
Father's Full Name
First Name Last Name
Phone Number
E-mail
Comments
CHILDREN'S INFORMATION
Child 1 Full Name*
First Name Last Name
Nickname Name child prefers to be called by
Birth Date*

Month Day Year
Gender*

MaleFemale
Child 2 Full Name
First Name Last Name
Nickname Name child prefers to be called by
Birth Date

Month Day Year
Gender

MaleFemale
Child 3 Full Name
First Name Last Name
Nickname Name child prefers to be called by
Birth Date

Month Day Year
Gender

MaleFemale
Child 4 Full Name
First Name Last Name
Nickname Name child prefers to be called by
Birth Date

Month Day Year
Gender

MaleFemale
EMERGENCY CONTACTS

Please list local contacts other than parents/guardians who are authorized to pick children up or make medical decisions in an emergency when parents/guardians cannot be reached.
Full Name*
First Name Last Name
E-mail*
Phone Number*
Relationship to Child*
Full Name*
First Name Last Name
E-mail*
Phone Number*
Relationship to Child*
Should be Empty:

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