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Chabad Jewish Center of Jupiter
JewishJupiter.com » Camp Gan Israel in Jupiter

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Online Application!

Please fill out the form below carefully.  
When you press submit, this form will be sent to the camp office.   
Camp personel will contact you within one week of receiving your registration.

Note: Please use a separate form for each child.

Camper/Parent Information
Camper
Name
   First 
Middle 
Last 

 Male  
Female 
Address
   Street 
City 
State 
Zip 
Date of Birth
    

Hebrew Birthday

   If unknown; please write time of birth  
Contact Info
   Phone 
Email 
 
School
   School 
Hebrew School 
Entering Grade 

Child is living with:

     Other: 
Camper's Mother
   Mother's Name 
Hebrew Name  Work Phone  
 		 Cell 
    Occupation 
Work Address 
Work Email 
 
Camper's Father
   Father's Name 
Hebrew Name 
Work Phone 
Cell  
    Occupation 
Work Address 
Work Email 
 
Emergency Information
Emergency Contact 1   Name 
Phone 
Relationship   
Emergency Contact 2   Name 
Phone 
Relationship 
 
Pediatrician
   Name 
Phone 
   
Medical Allergies   
Medications & Treatments   
           
Select Child's Grade
 
Entering Kindergarten

  Entering 1-2 Grade

Entering Grade 3-5  
 		 CIT 
   

Please indicate the weeks your child will attend camp  
 (additional weeks can be added throughout the camp season)
 

 Week 1 June 21-25

  Week 2 June 28-July 2  Week 3 July 5-10   
 Week 4 July 12-16    
   
 
 Will need early care (8:00-9:00 am) additional fee of $75 per week will apply
  Will need late care (3:00-5:00 pm) additional fee of $75 per week will apply
 


     
IMPORTANT
•
 All forms must be completed and submitted before your child begins camp.
•
 I will be paying by:  Check-Please make check payable to Chabad of Jupiter and mailed to 128 Glencullen Circle, Jupiter, FL 33458 Please bill me via google checkout. My email address is:
I have read the camp brochure and application form and agree to the terms stated.  I give my child permission to attend all trips, swim at the Palm Beach Gardens Aquatic Complex and receive medical care in the case of emergency
Must Check for  registrartion acceptance. 

There are no refunds of deposit monies whatsoever. 

Notes
  Date of Application: 

 

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Chabad Jewish Center of Jupiter • 128 Glencullen Circle • Jupiter, FL 33458-6534 • 561-694-6950

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