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CGI Registration

CGI Registration

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name
  First
Middle Last  
Address
  Street
City State
Zip
Date of Birth
   
Contact Info
  Phone
Email
 
Schools
  School
Hebrew School Entering Grade:
Child's Mother
  Mother's Name
Hebrew Name Work Phone Cell
Child's Father
  Father's Name
Hebrew Name Work Phone Cell
Emergency Contact Info
  Name
Phone Relationship  
Pediatrician
  Name
Phone    

Email

     
           
Child's Age
Age 5-9      
         
 
 
Please indicate number of sessions your child will attend camp:
 
     
IMPORTANT
All forms must be completed and submitted before your child begins camp.
I will be paying by: Check Mastercard Visa
I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.
   
PAYMENT INFORMATION:  $265 Per week. 
*Last Name   Charge Amt.
*First Name   CC Type
*Address   Card Number:
*City   Exp. Date
*State   CVV Code    3 digits on back of card
*Zip      
*Email      
  *Phone      

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