Register

Welcome to Lyndhurst Chabad Family Center Mini Gan Izzy Registration Form.

Mini's: Ages 3-5
Junior's: Ages 6-8
Pioneers: Ages 8-10

9:00am - 3:00pm

Week 1: August 7-11
Week 2: August 14-18
Week 3: August 21-25

Fees: (Lunch & Snack included)

Regular cost per week $250

Early bird discount cost per week $235
Register by March 1, 2023
1. Campers Information
Campers Name*

First Name Last Name
Nickname
Birth Date*

Month Day Year
Gender*
Age*
Grade entering in 2023/24*
School*

Home Address*

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

Home Phone Number*
I would like to register for the group*

Mini's: Ages 3-5Junior's: Ages 6-8Pioneers: Ages 8-10
2. Parents Infromation
Marital Status*
Which Parent has passed?*
Fathers Name*

First Name Last Name
Fathers Cell*
Fathers E-mail*
Where could the father be reached while child is at camp?*

Cell PhoneHome Phone
Mother's Name*

First Name Last Name
Mother's Cell*
Mother's E-mail*
Where could the Mother be reached while child is at camp?*

Cell PhoneHome Phone
please explain custody arrangements for drop off & pick-up
Whose address is different then above

Other Address

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

Are both parents Jewish?*

YesNo
Which parent is Jewish?*
Is there any Conversions or Adoption in the family?*

YesNo
Please Explain*
3. Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within half hour of camp, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact 1*

First Name Last Name
Emergency Contact 1 Cell*

Area Code Phone Number
Emergency Contact 1 relationship to camper*
Emergency Contact 2*

First Name Last Name
Emergency Contact 2 Cell*

Area Code Phone Number
Emergency Contact 2 relationship to camper*
4. Medical Information
Name of Physician or Clinic/Hospital*
Doctor Phone Number*

Area Code Phone Number
Is your child up to date with his immunizations?*

YesNo
Please Explain
Does your child have a special health, medical or allergic condition? Select all that apply

Health/MedicalAllergic
Medical Diagnosis
Allergic diagnosis
Does the special health or medical condition require camp staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during camp hours?*

Yes, Monitor & MedicationYes, Just medication at given timesNo, this condition is not something that has to be monitored during camp hours
Medication Type* Select all that apply

PrescriptionNon prescriptionRefrigeration requiredTopical product or lotion
Medication & Care details*
Yes, I give permission for my child to receive care based on above plan at Camp Mini Gan Izzy*

Yes
5. Fun Facts
T-shirt Size*
List a few things your child likes to eat for lunch
List a few things your child likes to eat for snack
what are some of your child talents?
6. Payment and Statements of Understanding
Terms & Conditions*

By checking off this box and writing in my name below I certify that all information in this form is correct.I give legal authorization to Camp Mini Gan Izzy to use some or all of the information in this form to the best of their ability to secure and provide a healthy environment for my child when they are in their care.I release Camp Mini Gan Izzy, its providers and administrators, from all liability for any incident which affects the health, welfare, or safety of my child in the provision of a program during the Summer of 2023.Camp Mini Gan Izzy has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.In case of emergency, I hereby give permission to the physician to secure necessary emergency medical treatment, anesthesia, or hospitalize my childI consent to have Camp Mini Gan Izzy staff share all pertinent medical information of my child with medical personnel.
Sunscreen Application Consent*

I give permission to the staff of Camp Gan Izzy to apply sunscreen on my child when necessary for outdoor activity.I do not give permission to the staff of Camp Gan Izzy to apply sunscreen on my child when necessary for outdoor activity.
Photos

I give permission for my child's photo to be used online and for PRI do not give permission for my child's photo to be used online and for PRPlease contact me prior to confirm picture and PR project
Full Name*

First Name Last Name
Confirmation E-mail*
I would like to register my child for the following weeks* Regular cost per week $250 Early bird discount cost per week $235 Register by March 1, 2023

Week 1 August 7-11 - $235Week 2 August 14-18 - $235Week 3 August 21-25 - $235
Total

$0.00

I would like to pay today:Full amount$100.00 minimum$
$100 Nonrefundable registration fee included in full price.

By selecting to pay the minimum $100 please understand that you agree to pay the remaining fee by June 30, 2023.

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number
Expiration Month	Expiration Year

Should be Empty:

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Camp Updates

TESTIMONIALS

Mini Gan Izzy has been so wonderful for my daughter! Incorporating Judaism and the classic camp experience into a unique and unforgettable few weeks! Amanda G.

My kids LOVED Mini Gan Izzy and Morah Chaya. For two years, its saved us from scrambling for childcare between camp and school with activities and meaningful Jewish learning. Jenny K.

Mini Gan Izzy is a special place with special people. Morah Chaya and her team created a warm, and loving environment complete with a variety of engaging activities. My son was excited to be dropped off every day, and knowing he was having fun and well cared for provided me with great comfort. We are very thankful for our experience at Mini Gan Izzy. Courtney M.

Upcoming Events

There are no events posted at this time. Please contact us for more info about our events.

Camp Gan Izzy, is short for Camp Gan Israel,

The international network of Camp by Chabad.

Camp Mini Gan Izzy is an affiliate of the Lyndhurst Chabad Family Center.

1. Campers Information

2. Parents Infromation

3. Emergency Contacts/Authorized Pickup

4. Medical Information

5. Fun Facts

6. Payment and Statements of Understanding