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2020 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 22 - 26
June 29 - July 2
July 6 - 10
July 13 - 17
June 22 - 26
June 29 - July 2
July 6 - 10
July 13 - 17

$50 per week, per camper suggested donation.*

$

Each registered camper will receive a personalized bucket of camp supplies delivered to their doorstep* on the Sunday before the first week of camp for which they registered. (*within the Greater San Gabriel and Pomona Valleys only)

In order to receive bucket of supplies registration must be received prior to the following deadlines:
Week 1 - Thursday, June 18
Week 2 - Tuesday, June 23
Week 3 - Tuesday, June 30
Week 4 - Tuesday, July 7

Please initial

* Financial assistance is available. For details email federation@jewishsgpv.org

Camper 2 Information

Boy
Girl
Non-Binary
I Would Prefer Not To Say
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
June 22 - 26
June 29 - July 2
July 6 - 10
July 13 - 17

$50 per week, per camper suggested donation.*

$

Each registered camper will receive a personalized bucket of camp supplies delivered to their doorstep* on the Sunday before the first week of camp for which they registered. (*within the Greater San Gabriel and Pomona Valleys only)

In order to receive bucket of supplies registration must be received prior to the following deadlines:
Week 1 - Thursday, June 18
Week 2 - Tuesday, June 23
Week 3 - Tuesday, June 30
Week 4 - Tuesday, July 7

Please initial

* Financial assistance is available. For details email federation@jewishsgpv.org

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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Total:   

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