Registration 2025 - jewishdanville.com

Camper Information

How many Campers are you registring?*

Camper 1

Name*

First Name Last Name

Hebrew Name (if known)

Date of Birth*

Month Day Year

Age*

Grade currently in:*

Gender*

Shirt Size*

Camper 2

Name*

First Name Last Name

Hebrew Name (if known)

Date of Birth*

Month Day Year

Age*

Grade currently in*

Gender*

Shirt Size

Camper 3

Name*

First Name Last Name

Hebrew Name (if known)

Date of Birth*

Month Day Year

Age*

Grade currently in:*

Gender*

Shirt Size

Parent Information

Father's Name*

First Name Last Name

Hebrew Name (if known)

Mobile*

Area Code Phone Number

E-mail*

Mother's Name*

First Name Last Name

Hebrew Name (if known)

Mobile*

Area Code Phone Number

E-mail*

Home Address*

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

Home Phone Number*

Medical and Special Needs Details

Is your child taking permanent medications?*

YesNo

If Yes, please specify:

Any known allergies (incl. reactions to medications) and any present medical conditions?*

YesNo

If Yes, please specify:

Does your child require the use of an epi-pen?*

YesNo

Is your child gluten-free?*

YesNo

If Yes, please list 2 snacks your child will enjoy:

Emergency Information

Emergency Contact*

First Name Last Name

Relationship to child*

Mobile*

Area Code Phone Number

Doctor's Name

First Name Last Name

Doctor's Telephone

Area Code Phone Number

Other Person Authorized to Pick-up Child

Name*

First Name Last Name

Relationship to child*

Mobile*

Area Code Phone Number

Address

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

Accident, Field Trip and Privacy Declaration

Accident

As the parent(s) or legal guardian of my/our child, I/we authorize any adult acting on behalf of Danville Hebrew School to hospitalize or secure treatment for my child; I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Danville Hebrew personnel will try, but are not required to communicate with me prior to such treatment.

Agreement*

I Agree

Date*

Month Day Year

Trips & Outings

I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Danville Hebrew.

Agreement*

I Agree

Date

Month Day Year

Privacy

I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, Danville Hebrew website and Danville Hebrew social media. I understand that I can withdraw my consent at any time.

Agreement*

I Agree

Date

Month Day Year

Billing

Will you be paying in Installments?*

YesNo

Installment Plan:* Prices will be automatically calculated upon payment.

2 months4 months6 months

Pricing

1st week attending $499

Each additional week attending $479

Camp Gan Izzy offers the following discounts, if you are in need of steeper discounts, please email [email protected]

Multi Week Discount: $20 discount off each additional week

Sibling Discount: $15 off per week for additional siblings registered

Camper Grant: We are happy to partner with Birthright Judaism to offer a $250 grant to new campers who have not attended a Jewish Camp in the past two years. Campers must register for at least two weeks to receive this offer. No income verification needed.

Register for grant here: https://www.birthright-judaism.org/daycamps

Please make all checks payable to Chabad of Danville & S. Ramon and mail to Chabad of Danville & S. Ramon P.O Box 3541 Danville CA 94526.

Child 1 Attending:*

Child 2 Attending:*

Child 3 Attending:*

Child 1 Attending:*

Child 2 Attending:*

Child 3 Attending:*

Child 1 Attending:*

Child 2 Attending:*

Child 3 Attending:*

Child 1 Attending:*

Child 2 Attending:*

Child 3 Attending:*

My child/children will be attending:* Please select all that apply:

Week 1: June 23-27Week 2: June 30 - July 4Week 3: July 7-11Week 4: July 14-18

I would like to make a tax deductible contribution to the Camp Scholarship Fund in the amount of

A limited number of scholarships are available upon request; no child will be turned away for lack of funds.

Payment

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 2.5%

Payment*

Credit Card Check

Notes

Summer Camp Enrollment Form 2025