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2021 Gan Shalom @ Home


Gan Shalom @ Home - 114A W. Lime Ave., Monrovia, 91016
Phone 626.445.0810 - Fax 626.445.5977
ganshalom@jewishsgpv.org

Please complete registration for each camper. This form only allows you to register up to two children. If you have more than two children, please complete another registration form

Camper 1 Information

Boy
Girl
Non-Binary
Prefer not to disclose
No
Yes

Please check the session(s) that the camper will be attending:

June 28 - July 2 $125.00
July 6 - July 8 $100.00
July 12 - July 16 $125.00
July 19 - July 23 $125.00

For each registered camper we will prepare a personalized bucket of camp supplies. Arrangements will be made for campers to receive it before the first week of camp for which they’re registered.

For us to prepare a bucket of supplies for your child, you must complete their registration before the following deadlines:
Week 1 - Friday, June 18
Week 2 - Friday, June 25
Week 3 - Friday, July 2
Week 4 - Friday, July 9

Please initial

Camper 2 Information

Boy
Girl
Non-Binary
Prefer not to disclose
No
Yes

Please check the session(s) that the camper will be attending:

June 22 - 26
June 29 - July 2
July 6 - 10
July 13 - 17

For each registered camper we will prepare a personalized bucket of camp supplies. Arrangements will be made for campers to receive it before the first week of camp for which they’re registered.

For us to prepare a bucket of supplies for your child, you must complete their registration before the following deadlines:
Week 1 - Friday, June 18
Week 2 - Friday, June 25
Week 3 - Friday, July 2
Week 4 - Friday, July 9

Please initial

Parent/Guardian Information

Both Parents
Parent/Guardian 1
Parent/Guardian 2
Shared custody
Other
Friend
Synagogue
Website
Eblast
Other

Camp Gan Shalom Agreement

Parent's/Guardian's initials

Parent's/Guardian's initials

Parent's/Guardian's initials

Parent's/Guardian's initials

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS A WET SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS A WET SIGNATURE.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

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