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Camp Gan Israel
fun forever!
ב"ה

Health Form

  • PERSONAL HEALTH AND MEDICAL INFORMATION

  • IN CASE OF AN EMERGENCY, PLEASE NOTIFY:

  • DISEASE OR PAST/PRESENT HISTORY OF:

  • If you select yes to any of these questions, please provide all details in the box below). 

  • MEDICAL HISTORY:

  • Pick a Date
  • AUTHORIZATION:

  • To the best of my knowledge, history is correct and complete, I know of no reason to restrict applicant's activity, and give my permission for participation in all activities except as specifically noted herein. In the event that I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for, and to order injection, anesthesia and/ or surgery for my child as named above.

  • at
    Pick a Date
  • Should be Empty:
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 Camp Dates 

Summer 2023

June 26th - July 21st