Registration Form

1. Contact Information

Primary Contact

Full Name*

First Name Last Name

E-mail*

Phone Number*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Relationship to child/ren*

Marital Status*

Secondary Contact

Full Name*

First Name Last Name

E-mail*

Phone Number*

Relationship to child/ren*

Emergency Contact

Full Name*

First Name Last Name

E-mail*

Phone Number*

Relationship to child/ren*

Physician's Name*

Physician's Phone Number*

2. Child Information

How many children will you like to register?

Child 1

Full Name*

First Name Last Name

Birth Date*

Month Day Year

Please let us know if there are any allergies, medications or other information we should be aware of.

The Kids Gan runs Monday through Friday from 9:00 AM to 2:00 PM.

Weeks 1 and 2: $300.00 per week
Week 3: $240.00 for the week. There will be no camp on Thursday July 23.

Please Select

Summer Gan Week #1: July 6-July 10Summer Gan Week #2: July 13-July 17Summer Gan Week #3: July 20-22 & 24

Child 2

Full Name

First Name Last Name

Birth Date

Month Day Year

Please let us know if there are any allergies or other information we should be aware of.

The Kids Gan runs Monday through Friday from 9:00 AM to 2:00 PM.

Weeks 1 and 2: $300.00 per week
Week 3: $240.00 for the week. There will be no camp on Thursday July 23.

Please Select

Summer Gan Week #1: July 6-July 10Summer Gan Week #2: July 13-July 17Summer Gan Week #3: July 20-22 & 24

Child 3

Full Name

First Name Last Name

Birth Date

Month Day Year

Please let us know if there are any allergies or other information we should be aware of.

The Kids Gan runs Monday through Friday from 9:00 AM to 2:00 PM.

Weeks 1 and 2: $300.00 per week
Week 3: $240.00 for the week. There will be no camp on Thursday July 23.

Please Select

Summer Gan Week #1: July 6-July 10Summer Gan Week #2: July 13-July 17Summer Gan Week #3: July 20-22 & 24

3. Payment Information

Total

$0.00

Payment

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Credit Card Check

Postal / Zip Code

Country

Payment Plan

Pay in fullPay in installments.

Your card will be charged once your registration will be approved.

I would like to receive news and updates by email

*

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Mini Gan to hospitalize or secure treatment for my child. I hereby allow my child to be photographed while participating in activities and that these pictures may be used for marketing purposes.

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