Camper Registration By Day | www.ganisraelberkeley.com

Parent's Info

First Name *

Last Name *

Phone Number *

Email *

Street Address *

City *

Postal Code *

State/Province *

Camper

How many days are you registering for? (75$ Per Day) *

Please list which days *

First Name *

Last Name *

Gender *

Birth Date *

Month

Day

Year

Shirt Size *

Select Group *

You have the same address as:

Same address as parent

Street Address *

City *

Postal Code *

State/Province *

Name any Allergies

List any medical conditions we should be aware of

Emergency Contact Info

First Name *

Last Name *

Cell Number *

Work Number *

Email *