EARLY BIRD REGISTRATION FORM FOR SUMMER 2027 June 28-August 18 REGISTER TODAY TO SAVE YOUR SPOT: SIGN UP EARLY BIRD AND SAVE $800 FOR THE SUMMER PER CHILD / $100 PER WEEK Based on 4 Tier Pricing: Tier 4 $575 per week: Elective options can be added individually (EARLY BIRD $475 WEEKLY) Tier 3 $675 per week: Includes all elective besides door to door bussing (EARLY BIRD $575 WEEKLY) Tier 2 $775 per week: Includes all elective options including bussing (EARLY BIRD $675 WEEKLY) Tier 1 $875 per week: Includes twice a week of each elective options (or choose any elective up to three times per week, add in notes) (EARLY BIRD $775 WEEKLY) Additional Savings Off The Total: *Save five percent with the siblings discount *Work part time for Camp Gan Israel and get large discounts *Special Referral Discount - Save $500 for each family that you refer that signs up *Special Referral Discount - Save $750 for each family that you refer that signs up before Aug 1st 2026 for camp 2027. Child 1 Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Info Grade Entering School Attending Any Allergies NoYes - list all allergies below Allergies T-Shirt Size Kids SmallKids MediumKids Large Camp runs for 8 weeks from Monday, June 28th - Wednesday, August 18 No Camp July 4th. No Camp Tisha Bav August 12. Last week is partial week and counted as one full week for pricing (based on 3 tier pricing for the amount of days in those weeks) Dates Attending Check all that apply Week 1: 6/28 - 7/1Week 2: 7/5 - 7/9Week 3: 7/12 - 7/16Week 4: 7/19 - 7/23Week 5: 7/26 - 7/30Week 6: 8/2 - 8/6Week 7: 8/9 - 8/13Week 8: 8/16 - 8/18 Choose Your Tier / Tuition Rate Tier 4: $575.00 weeklyTier 3: $675.00 weeklyTier 2: $775.00 weeklyTier 1: $875.00 weekly Please click on the electives you would like to choose: (electives can be added or changed at anytime) Tier 1 won't be charged additional for electives chosen Tier 2 won't be charged additional for electives chosen Tier 3 won't be charged additional for electives chosen (except Transportation) Tier 4 will be charged the prices listed Additional Electives Options Door to door busing $125.00/weekSwimming Lessons $45/weekLunch $ 45/weekHorseback Riding Lessons $75/week Child 2 Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Info Grade Entering School Attending Any Allergies NoYes - list all allergies below Allergies T-Shirt Size Kids SmallKids MediumKids Large Dates Attending Check all that apply Week 1: 6/28 - 7/1Week 2: 7/5 - 7/9Week 3: 7/12 - 7/16Week 4: 7/19 - 7/23Week 5: 7/26 - 7/30Week 6: 8/2 - 8/6Week 7: 8/9 - 8/13Week 8: 8/16 - 8/18 Please click on the electives you would like to choose: (electives can be added or changed at anytime) Tier 1 won't be charged additional for electives chosen Tier 2 won't be charged additional for electives chosen Tier 3 won't be charged additional for electives chosen (except Transportation) Tier 4 will be charged the prices listed Choose Your Tier / Tuition Rate Tier 4: $575.00 weeklyTier 3: $675.00 weeklyTier 2: $775.00 weeklyTier 1: $875.00 weekly Additional Electives Options Door to door busing $125.00/weekSwimming Lessons $45/weekLunch $ 45/weekHorseback Riding Lessons $75/week Child 3 Full Name First Name Last Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Info Grade Entering School Attending Any Allergies NoYes - list all allergies below Allergies T-Shirt Size Kids SmallKids MediumKids Large Dates Attending Check all that apply Week 1: 6/28 - 7/1Week 2: 7/5 - 7/9Week 3: 7/12 - 7/16Week 4: 7/19 - 7/23Week 5: 7/26 - 7/30Week 6: 8/2 - 8/6Week 7: 8/9 - 8/13Week 8: 8/16 - 8/18 Additional Electives Options Door to door busing $125.00/weekSwimming Lessons $45/weekLunch $ 45/weekHorseback Riding Lessons $75/week Please click on the electives you would like to choose: (electives can be added or changed at anytime) Tier 1 won't be charged additional for electives chosen Tier 2 won't be charged additional for electives chosen Tier 3 won't be charged additional for electives chosen (except Transportation) Tier 4 will be charged the prices listed Choose Your Tier / Tuition Rate Tier 4: $575.00 weeklyTier 3: $675.00 weeklyTier 2: $775.00 weeklyTier 1: $875.00 weekly Mother's Info Full Name First Name Last Name Cell Number Area Code Phone Number Mother Jewish YesNoConverted OrthodoxConverted ConservativeConverted Reform Home Number Area Code Phone Number E-mail Address Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Father's info Full Name First Name Last Name Father Jewish YesNoConverted OrthodoxConverted ConservativeConverted Reform Cell Number Area Code Phone Number Home Number Area Code Phone Number E-mail Address Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Emergency Contact Information Please provide 2 emergency contacts besides parents Contact 1 First Name Last Name Relationship to Child Cell Number Area Code Phone Number E-mail Contact 2 First Name Last Name Relationship to Child Cell Number Area Code Phone Number E-mail Special Notes First Year Camper(s) at CGI NoYes If you were referred to Camp Gan Israel by a friend, please type here their first and last name or business name Promo Code - Optional *Save five percent with the siblings discount SPECIAL REFERRAL SAVINGS SAVE $500 FOR EACH FAMILY REFERRED Amount to charge: Minimum Deposit per child $750 Terms and Conditions* I, the undersigned agree, understand and authorize the amount shown above to be charged to my credit card for the items shown on the referenced order. I understand these charges will appear on my credit card statement under my name and I accept full financial responsibility for payment of this order. Camp Gan Israel reserves the right to take pictures of campers and share it on our website and publications, unless specifically asked otherwise. By entering your email you are accepting the terms above* Payment Options:If you have any questions, please call us at 631-213-7502. Thank you. Payment ⚠ You have not yet connected a credit card processor.Credit Card eCheck Check or cash Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration Year Bank Name Routing Number Account NumberCheckingSavingsBusiness Account TypePlease mail check to our office, 498 Sweet Hollow, Rd, Melville, NY 11747 or call to bring a check / cashTo pay by Zelle, send to 631-827-6599Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country CVV Comments Should be Empty: Submit This page uses TLS encryption to keep your data secure.