Gan Shalom Summer Camp Registration - Form

2026 REGISTRATION

CHILD INFORMATION

Please complete the information for your child. If you’re registering two children, use the second section provided. Otherwise, leave blank.

* First Name

* Last Name

* Birthdate

Allergies?

First Name

Child 2

Last Name

Child 2

Birthdate

Child 2

Allergies?

Child 2

EMERGENCY CONTACT INFORMATION

Please enter the name and phone number of the person we should contact in case of an emergency.

* Emergency Contact

PARENT/GUARDIAN INFORMATION

Please complete the information for the parent/guardian. If there are two parents/guardians, use the second section provided. Otherwise, leave blank.

* First Name

PARENT/GUARDIAN 1

* Last Name

PARENT/GUARDIAN 1

* Relationship to Child

PARENT/GUARDIAN 1

* Email

PARENT/GUARDIAN 1

* Phone Number

PARENT/GUARDIAN 1

First Name

PARENT/GUARDIAN 2

Last Name

PARENT/GUARDIAN 2

Relationship to Child

PARENT/GUARDIAN 2

Phone Number

PARENT/GUARDIAN 2

ENROLLMENT INFORMATION

Camp tuition is $500/week for Hill Havurah members and $625/week for non-members. Children may attend any combination of weeks.

* Select the week(s) you’d like to enroll your child(ren)

* Are you a Hill Havurah member?

YesNoThere is a $45 non-refundable registration fee for non-members.

Total

You will receive an email confirming we have space for your child and instructions for payment. A $250 deposit per session is required to secure your spot. Please note: Your enrollment must be paid in full by May 22.