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Camper Information 

First Name:

Last Name :



What part of camp will you be joining?

1st  2nd 3rd
Previous camp experience:

Does your child swim?
Yes No 
Swim Level: List most recent American Red Cross child earned, date and place.


Medical Information

Date of last health examination:
Any recent surgery/serious illness?

Does your child have any mental or social handicap or any other problem of which we should be aware of in caring for him/her?

Does your child take medication regularly? if so, what kind?

Does your child have any allergies?
Yes  No 

List any known allergies:

How severe is your child's reaction?
Mild  Moderate  Severe 
What treatment is required for reaction?

Name, Address and phone number of Doctor:

Do you give Camp Gan Isreal the permission to render any necessary first aid or care by physician to child while attending camp?
Yes  No 


First Camper

Is this the first camper you are regestering for camp this year?
Yes  No 

Parent Information

Father's Name:
Father's Contact Number:

Father's Email:

Mother's Name:

Mother's Contact Number:

Mother's Email:

Emergency Contact (other than parents):

Please list any of your children that have permission to wallk home. (2nd grade and higher):

I give Camp Gan Israel permission to photograph and/or videotape my child/children while participating in events/activities hosted by Camp Gan Israel of Greater Daytona.
Yes  No 



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Camp Gan Israel 1079 West Granada Blvd. Ormond Beach, FL 32174 386-672-9300
A branch of the world's largest Jewish Camping network, Camp Gan Israel International

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