Gan Kids Cluc Registration Form - Melville Chabad Center

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REGISTRATION FORM

REGISTER TODAY TO SAVE YOUR SPOT:

Based on 3 Tier Pricing:

Tier 3 $125 per week: Elective not included (or $35 daily)
Tier 2 $150 per week: Some elective included (or $40 daily)
Tier 1 $200 per week: Includes most electives (or $55 daily)

Additional Savings Off The Total:
*Save five percent with the siblings discount
*Save five percent when you register by the month
*Work part time for GKC and get large discounts
*Special Referral Discount - Save $500 for each family that you refer that signs up

Child 1

Full Name

First Name Last Name

Birth Date

Month Day Year

School Info

Grade Entering School Attending

Any Allergies

NoYes - list all allergies below

Allergies

T-Shirt Size

Months Attending Check all that apply

Days of the week

Please enter the exact dates you are looking for, either the first day of each week if you want the full week or the specific day(s) you need.

Choose Your Tier / Tuition Rate

Tier 3: $125.00 weeklyTier 2: $150.00 weeklyTier 1: $200.00 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 electives additional

Additional Electives Options

Door to door busing $55.00/weekSwimming Lessons $25/lessonDinner $ 45/weekHorseback Riding Lessons $80/lesson

Child 2

Full Name

First Name Last Name

Birth Date

Month Day Year

School Info

Grade Entering School Attending

Any Allergies

NoYes - list all allergies below

Allergies

T-Shirt Size

Months Attending Check all that apply

Days of the week

Please enter the exact dates you are looking for, either the first day of each week if you want the full week or the specific day(s) you need.

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 electives additional

Choose Your Tier / Tuition Rate

Tier 3: $125.00 weeklyTier 2: $150.00 weeklyTier 1: $200.00 weekly

Additional Electives Options

Door to door busing $55.00/weekSwimming Lessons $25/lessonDinner $ 45/weekHorseback Riding Lessons $80/lesson

Mother's Info

Full Name

First Name Last Name

Cell Number

Area Code Phone Number

Mother Jewish

Home Number

Area Code Phone Number

E-mail

Address

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

Father's info

Full Name

First Name Last Name

Father Jewish

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 Code	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 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. Gan Kids Club 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.

Zelle to 631-827-6599

Or Credit Card

Credit Card Number

Exp Month / Year

CVV

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