Register

Address where child resides*

Does your child have any allergies or other medical conditions we should be aware of? If yes, please describe them and indicate special precautions necessary:
Parent Information:
Father's Name*
First NameLast Name
Mother's Name*
First NameLast Name
Father's E-mail*
Mother's E-mail*
Father's Cell*
Area CodePhone Number
Mother's Cell*
Area CodePhone Number
How did you hear about us?
Payment:
If discounts apply please enter total here:
Full Session
$1,200
Week 1 (June 27- July 1)
$325
Week 2 (July 5- July 8)
$325
Week 3 (July 11- July 15)
$325
Week 4 (July 18- July 22)
$325
Notes regarding payment, please specify any discount applied:
Total
$0.00

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates by email
*
I agree to not hold liumi Inc. liable for any and all circumstances that may accur while my child is in Camp Gan Izzy
*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Camp Gan Izzy to hospitalize or secure treatment for my child. I hereby give permission for my child to participate in all activities, join sports and trips on and beyond camp properties and allow my child to be photographed while participating in activities and that these pictures may be used for marketing purposes.
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