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2022 Camp Gan Shalom Camper Registration Form


Camp Gan Shalom c/o Jewish Federation- 114A W. Lime Ave., Monrovia, CA 91016
Phone 626.445.0810 - Fax 626.445.5977
ganshalom@jewishsgpv.org
*** PLEASE DO NOT USE ONLINE REGISTRATION IF YOU ARE APPLYING FOR A SCHOLARSHIP. PLEASE DOWNLOAD THE REGISTRATION AND SCHOLARSHIP FORM FROM OUR WEBSITE AND SEND IT TO OUR OFFICE ***

Camper 1 Information

Boy
Girl
Non-Binary
Prefer not to disclose

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

Pasadena Jewish Temple & Center
1434 N. Altadena Dr., Pasadena

June 13 - 17 $295.00
June 20 - 24 $295.00
June 27 - July 1 $295.00
July 5 - 8 (No camp on 7/4) $275.00
July 11 - 15 $295.00
SALES END PRICE QUANTITY
June 13 - 17 06/17/2022 $335.00
June 20 - 24 06/24/2022 $335.00
June 27 - July 1 07/01/2022 $335.00 We have reached maximum capacity for this week. Please send an email to bphelps@jewishsgpv.org to be added to the wait list.
July 5 - 8 (No camp on 7/4) 07/08/2022 $315.00
July 11 - 15 07/15/2022 $335.00

Temple Beth Israel of Pomona
3033 N. Towne Avenue, Pomona

July 18 - 22 $295.00
July 25 - 29 $295.00
August 1 - 5 $295.00

Multiple Week Discount: If your child is attending more than one week of camp, you will receive a discount. Please type the number of weeks your child is attending into the corresponding box to get the discount. Please make sure to pick the correct box, corresponding to the number of weeks your child is attending. Please note that we apply the multiple-week discounts per camper. If you have any questions, feel free to contact our office at 626.445.0810

Enter the number of weeks if 2 - 3 per camper

Enter the number of weeks if 4 - 5 per camper

Enter the number of weeks if 6 - 8 per camper

After-camp Care
There is either a $12 per day or $50 per week fee for any camper who stays for After-camp care.

The regular camp day runs from 9:00 a.m. to 3:30 p.m. Before and after regular camp hours, extended care begins at 7:30 a.m. and ends at 6:00 p.m. There is either a $12 per day or $50 per week fee for any camper who stays for after-camp care.

Enter the number of days your camper will stay for after-camp care each week.

Enter the number of weeks your camper will stay for after-camp care

Camper 2 Information

Boy
Girl
Non-Binary
Prefer not to disclose

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

Pasadena Jewish Temple & Center
1434 N. Altadena Dr., Pasadena

June 13 - 17 $295.00
June 20 - 24 $295.00
June 27 - July 1 $295.00
July 5 - 8 (No camp on 7/4) $275.00
July 11 - 15 $295.00
SALES END PRICE QUANTITY
June 13 - 17 06/17/2022 $335.00
June 20 - 24 06/24/2022 $335.00
June 27 - July 1 07/01/2022 $335.00 We have reached maximum capacity for this week. Please send an email to bphelps@jewishsgpv.org to be added to the wait list.
July 5 - 8 (No camp on 7/4) 07/08/2022 $315.00
July 11 - 15 07/15/2022 $335.00

Temple Beth Israel of Pomona
3033 N. Towne Avenue, Pomona

July 18 - 22 $295.00
July 25 - 29 $295.00
August 1 - 5 $295.00

Multiple Week Discount: If your child is attending more than one week of camp, you will receive a discount. Please type the number of weeks your child is attending into the corresponding box to get the discount. Please make sure to pick the correct box, corresponding to the number of weeks your child is attending. Please note that we apply the multiple-week discounts per camper. If you have any questions, feel free to contact our office at 626.445.0810

Enter the number of weeks if 2 - 3 per camper

Enter the number of weeks if 4 - 5 per camper

Enter the number of weeks if 6 - 8 per camper

After-Camp care
There is either a $12 per day or $50 per week fee for any camper who stays for After-camp care

Enter the number of days your camper will stay for after-camp care each week.

Enter the number of weeks your camper will stay for after-camp care

Parent or Guardian Information

Both Parents/Guardians
Parent 1/Guardian 1
Parent 2/Guardian 2
Other
Friend
Synagogue
Mailing
Other

(Check all that may apply)

Consider making a 100% tax-deductible gift to the Jewish Federation of the Greater San Gabriel and Pomona Valleys

The Jewish Federation of the Greater San Gabriel and Pomona Valleys focuses its energies on building a community that takes pride in strengthening and enhancing Jewish life in our community. Our Jewish Federation sponsors and facilitates programs throughout the year that: gives people a sense of pride in their Judaism; brings Jews from across the greater San Gabriel and Pomona Valleys together for Jewish events and causes; serves as a voice to the broader community; and much more. Your donation will greatly assist us in making all this possible in and for our community.

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Camp Gan Shalom Agreement

1. I hereby enroll my child in Camp Gan Shalom, the Jewish Federation of the Greater San Gabriel and Pomona Valleys summer day camp program, and agree to pay the established fee for my child's session(s).

2. The applicant and camper agree to abide by the camp's policies and regulations. Camp Gan Shalom reserves the right to reject any application, dismiss any camper for not conforming thereto, or cancel any program due to insufficient registration. If the camper withdraws or is sent home during the summer, there shall be no refund of fees.

3. Due to the ongoing COVID-19 pandemic, the applicant understands that we may cancel our in-person program at any time, before or during our camp program, if we feel we cannot comply with the federal, state, county, and local health and safety regulations and guidelines concerning summer camps and daycare centers in force at the time. If we cancel camp before it begins, a full refund will be issued. If camp is canceled during your child's registered session(s), you will receive a prorated refund.

4. The applicant and camper agree to abide by all COVID-19 policies and regulations of Camp Gan Shalom and of the Jewish Federation, including but not limited to the following: the camper must be fully vaccinated (if eligible) for COVID-19 at least two weeks before their first day at camp. Clarifying details and additional and/or superseding policies and regulations will be enumerated on a separate COVID-19 Waiver and Release form.

5. The camp does not assume responsibility for loss or damage to baggage or personal belongings during the period a camper is at camp. The applicant and camper agree to reimburse the camp for any unforeseen expenses the camp incurs on the camper's behalf (special supplies or emergency expenses, etc.).

6. Before the start of their camp session, all parents/guardians of campers must submit written verification of the camper's good health and suitability to participate in the programs selected.

7. The undersigned consents to the use of the camper's name, photograph, or other identification by the Jewish Federation, in connection with the camp's or Federation's programs, exchanges, or publicity.

8. I hereby certify that all information given is true and correct, and I agree to all the agreement provisions.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. ACCORDINGLY, THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Account Details

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Payment Information

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