Enrollment

Summer Camp Enrollment Form 2025
Parent Information
Parent 1*
First Name Last Name
Background
Hebrew Name (if known)
Mobile*

Area Code Phone Number
E-mail*
Parent 2*
First Name Last Name
Background
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

Camper Information
How many Campers are you registering?*
Camper 1
Name*
First Name Last Name
Hebrew Name (if known)
Date of Birth*

Month Day Year
Age*
Grade currently in:*
Gender*
Shirt Size*

XSSMLXL2XL
Please order an extra T-Shirt
Each child receives one complimentary shirt needed for trip day
Please provide Hot & Nutritious Daily Lunches to my child $35 a week

Week 1Week 2Week 3
Camper 2
Name*
First Name Last Name
Hebrew Name (if known)
Date of Birth*

Month Day Year
Age*
Grade currently in*
Gender*
Shirt Size

XSSMLXL2XL
Please order an extra T-Shirt
Each child receives one complimentary shirt needed for trip day
Please provide Hot & Nutritious Daily Lunches to my child $35 a week

Week 1Week 2Week 3
Camper 3
Name*
First Name Last Name
Hebrew Name (if known)
Date of Birth*

Month Day Year
Age*
Grade currently in:*
Gender*
Shirt Size

XSSMLXL2XL
Please add extra an T-Shirt
Each child receives one complimentary shirt needed for trip day
Please provide Hot & Nutritious Daily Lunches to my child $35 a week

Week 1Week 2Week 3
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:

AllergiesNut AllergyAsthmaAnaphylaxisOther
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:
Are your child's immunizations current for the State of California's school requirements?

YesNo
Does your child have any behavioral, emotional, physical, or mental health issues that we should be aware of?

YesNo
Please describe:
Emergency Information
Emergency Contact*
First Name Last Name
Relationship to child*
Mobile*

Area Code Phone Number
Doctor's 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
General Information
(Optional for returning campers)
Previous Camps Attended:
How did you hear about Camp Gan Izzy?
What goals would you like to see your child/ren accomplish during camp?
Child/ren's favorite activities:
Briefly describe your child/ren's personality:
Comments:
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 Chabad of Fremont 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, Chabad of Fremont personnel will try, but are not required to communicate with me prior to such treatment.
Agreement*

I Agree
Date*

Month Day Year
Trips & OutingsI hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Chabad of Fremont.
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, Chabad Fremont website and Chabad Fremont social media. I understand that I can withdraw my consent at any time.
Agreement*

I Agree
Date

Month Day Year
Billing
Use Discount Code EARLYBIRD
Save $75 before March 14
Discount Code
Will you be paying in Installments?*

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

2 months4 months6 months
Pricing

Full Tuition
- 1st & 2nd week attending $475
- 3rd week attending $399
Subsidized Tuition
- 1st & 2nd week attending $399
- 3rd week attending $349
Early Bird Discount
- Use discount code: EARLYBIRD to Save $75 Before March 1st
-
Daily Hot & Nutritious Lunch
- $35 a week
Click here for Extended Care Registration or go to ChabadFremont.com/extendedcare
Camp Gan Izzy offers the following discounts, if you are in need of steeper discounts, please email [email protected]
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

-

No tuition will be refunded due to absences.
Discount
Child 1 Attending:*
Pay in Full - Child 1 Attending:
Child 2 Attending:*
Pay in full - Child 2 Attending
Child 3 Attending:*
Pay in Full - Child 3 Attending:
Child 1 Attending:*
2 Months - Child 1 Attending:
Child 2 Attending:*
2 Months - Child 2 Attending:
Child 3 Attending:*
2 Months - Child 3 Attending:
Child 1 Attending:*
4 Months - Child 1 Attending:
Child 2 Attending:*
4 Months - Child 2 Attending:
Child 3 Attending:*
4 Months - Child 3 Attending:
Child 1 Attending:*
6 Months - Child 1 Attending:
Child 2 Attending:*
4 Months - Child 2 Attending:
Child 3 Attending:*
4 Months - 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 7-11
I would like to make a tax deductible contribution and help subsidize a child's Tuition in the amount of

YesNo
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 Paypal Check

Notes
Should be Empty:

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Summer Camp Enrollment Form 2025

Parent Information

Camper Information

Medical and Special Needs Details

Emergency Information

Other Person Authorized to Pick-up Child

General Information

Accident, Field Trip and Privacy Declaration

Billing

Payment