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Chelsea Gan Registration Form - Summer 2021

  • Camper Information

  • School

  • Medical Information

  • Parent Information

  • Home Information

  • Emergency Contact

  • Someone we can contact in case parents cannot be reached

  • Dates & Rates

  • Whole Session Discounted Rate

  • Weekly Rate

  • Payment

  • A $360 deposit is required to reserve your spot. 

  • $0.00

  • Credit Card
    Billing Address
  • Parental Consent

  • By writing my name in the box below I agree to the following terms: I hereby permit my child to participate in all activities at The Chelsea Gan, on-site, off-site and on any trips. I release The Chelsea Shul and all individuals from any liability arising out of any injury to my child. I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision. In the event of a medical or surgical emergency, I grant permission to the physician designated by The Chelsea Shul and/or The Chelsea Gan to hospitalize, secure proper treatment for and order injections, anesthesia or surgery for my child. Furthermore I understand that payment for medical services is solely the family’s responsibility.

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