Enrollment

Parent 1*

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

Parent 2*

First Name Last Name

Background

Hebrew Name (if known)

Mobile*

Area Code Phone Number

E-mail*

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*

Please order an extra T-Shirt

Each child receives one complimentary shirt needed for trip day

1 Additional Shirt Pay Now

2 Additional Shirts Pay Now

Please provide Hot & Nutritious Daily Lunches to my child $40 a week

Week 1Week 2

Week 1 - Lunch Pay Now

Week 2 - Lunch Pay Now

I'd like to enroll my child into Extended Care *

YesNo

Camper 2

Name*

First Name Last Name

Hebrew Name (if known)

Date of Birth*

Month Day Year

Age*

Grade currently in*

Gender*

Shirt Size

Please order an extra T-Shirt

Each child receives one complimentary shirt needed for trip day

1 Additional Shirt Pay Now

2 Additional Shirts Pay Now

Please provide Hot & Nutritious Daily Lunches to my child $40 a week

Week 1Week 2

Week 1 - Lunch Pay Now

Week 2 - Lunch Pay Now

I'd like to enroll my child into Extended Care

YesNo

Camper 3

Name*

First Name Last Name

Hebrew Name (if known)

Date of Birth*

Month Day Year

Age*

Grade currently in:*

Gender*

Shirt Size

Please add extra an T-Shirt

Each child receives one complimentary shirt needed for trip day

1 Additional Shirt Pay Now

2 Additional Shirts Pay Now

Please provide Hot & Nutritious Daily Lunches to my child $40 a week

Week 1Week 2

Week 1 - Lunch Pay Now

Week 2 - Lunch Pay Now

I'd like to enroll my child into Extended Care

YesNo

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:

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 Contact*

First Name Last Name

Relationship to child*

Mobile*

Area Code Phone Number

Doctor's Name*

Doctor's Telephone

Area Code Phone Number

Name

First Name Last Name

Relationship to child

Mobile

Area Code Phone Number

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: 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

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 Chabad of Fremont.

Agreement*

I Agree

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

Pricing

Full Tuition

1st & 2nd week attending $475

Subsidized Tuition

1st & 2nd week attending $399

Daily Hot & Nutritious Lunch + Snacks

$40 a week

Extended Care

Camp Gan Izzy provides nurturing and enjoyable EarlyCare and Aftercare.

EarlyCare takes place at the Fuss Home and AfterCare takes place at Camp Gan Izzy

Dates: June 29 - July 10, 2026

Monday - Friday

Early Care 8:00 - 9:00 am $60 a week

After Care 3:30 - 5:00 pm $99 a week

Discount / Voucher

Early Bird Discount: Save $75 (per family) with our Early Bird Special! (Ends March 14).

Subsidized Tuition: Camp Gan Izzy offers subsidized tuition for families going through challenging financial times. If you are in need of steeper discounts, you can apply here for a scholarship

New Camper Voucher: 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.

Will you be paying in Installments?*

YesNo

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

2 months4 months6 months

Save $75 before March 14
Use Discount Code EARLYBIRD

Discount Code EARLYBIRD

Discount EARLYBIRD

Discount Code Birthright Judaism

Discount Code - Child 2 Birthright Judaism

Discount New Camper Voucher

Discount - Child 2 New Camper Voucher

Child 1 Attending:*

Child 2 Attending:*

Child 3 Attending:*

Child 1 Attending:* 2 Month Installment Plan

Child 2 Attending:* 2 Month Installment Plan

Child 3 Attending:* 2 Month Installment Plan

Child 1 Attending:* 4 Month Installment Plan

Child 2 Attending:* 4 Month Installment Plan

Child 3 Attending:* 4 Month Installment Plan

Child 1 Attending:* 6 Month Installment Plan

Child 2 Attending:* 6 Month Installment Plan

Child 3 Attending:* 6 Month Installment Plan

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 29 - July 3Week 2: July 6 - July 10

Camp Gan Izzy provides nurturing and enjoyable EarlyCare and Aftercare.

EarlyCare takes place at the Fuss Home and AfterCare takes place at Camp Gan Izzy

Dates: June 29 - July 10, 2026

Monday - Friday

Early Care 8:00 - 9:00 am $60 a week

After Care 3:30 - 5:00 pm $99 a week

Child 1 - EarlyCare

Child 1 - AfterCare

Child 2 - EarlyCare

Child 2 - AfterCare

Child 3 - EarlyCare

Child 3 - AfterCare

Child 1 - EarlyCare

Child 1 - AfterCare

Child 2 - EarlyCare

Child 2 - AfterCare

Child 3 - EarlyCare

Child 3 - AfterCare

Child 1 - EarlyCare

Child 1 - AfterCare

Child 2 - EarlyCare

Child 2 - AfterCare

Child 3 - EarlyCare

Child 3 - AfterCare

Child 1 - EarlyCare

Child 1 - AfterCare

Child 2 - EarlyCare

Child 2 - AfterCare

Child 3 - EarlyCare

Child 3 - AfterCare

I would like to make a tax deductible contribution and help subsidize a child's Tuition in the amount of

YesNo

Total Payment Today

$0.00

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

Installment Payments: If you choose to pay by installments, the following apply:

• Lunch and extra T-shirt fees are not included in the total shown on this form and will be charged with the final installment
• The $75 Early Bird discount (for registrations before March 14) and the New Camper Voucher will be applied to the final installment(s)

Yes, I'd like to make this a monthly recurring payment.

Payment*

Credit Card Paypal Check

Notes

Summer Camp Enrollment Form 2026

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

Extended Care

Scholarship Fund Donation

Payment