Gan Israel - summer program registration

Address*

Home Phone Number*

Area Code Phone Number
Emergency Phone Number*

Area Code Phone Number
Father's Name*

First Name Last Name
Mobile Number*

Area Code Phone Number
Mother's Name*

First Name Last Name
Mobile Number*

Area Code Phone Number
Does your child have any allergies or illnesses?*
Is there anything your child cannot eat or drink?*
What is the child's first spoken language?*
Second language?
Any other useful information?
I agree that my child may attend all activities, including sports, games, trips, swimming etc:

Parents signature: ...............................................................................................................

Please sign and print.

Payment*

Credit Card

CVV Back of card*
Price per child € 126.00. Special discount of five percent for 2 children

€126 EUR €240 EUR
Second week price per child € 100.00. Special discount of five percent for 2 children

€100 EUR €180 EUR
Total

€0.00 EUR
Should be Empty:

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