CAMP GAN ISRAEL REGISTRATION FORM SUMMER 2026 טופס הרשמה לקעמפ גן ישראל – קיץ 2026 .Important information about ages, dates, location, price, and food מידע חשוב לגבי גילאים, תאריכים, מיקום, מחיר ואוכל עברית בהמשך Please read until the end before filling out the form: DATES: Sunday August 2nd - Thursday August 20th Camp will run from from 8:45am - 2:30pm with Options for Early & After Care.(details below) Week One: (5 days) Sunday, August 2 until Thursday, August 6 Week Two: (5 days) Sunday, August 9 until Thursday, August 13 Week Three: (5 days) Sunday, August 16 until Thursday, August 20 AGES & DIVISIONS: Tiny Tots - Boys & Girls going into Gan 4 who have a sibling in older divisions. Tiny Tots will be at a separate location in Dagan There is a large demand for this age and for now we are only accepting children who have a sibling in older division Email us to be added to the waitlist: [email protected] Kiddie Camp: Boys & Girls Ages going into Gan Chova Big Kids Division (Goes on trips): Kids Going into 1st Grade + (boys until 8, Girls until 9) CIT Teen Girls Division: Girls ages 10-12 LOCATION Camp will take place at the Matnas in Alumim School, Dagan 5 Hakatzir. The space consists of 6 bunk rooms, Basketball court, a large miklat & a large outdoor area. LUNCH With the general increase in prices across the board, we’re doing our best to keep camp fees as affordable as possible. One way we’re making this happen is by offering families the option to send lunch from home. Sign-up HERE for hot lunch at an additional cost. **In addition to lunch, Aruchat Eser must be sent from home for all campers and will not be provided in camp. TRIPS: Children going into 1st Grade+ will go on exciting trips 1-2 times a week! The Gan Chova bunks will enjoy special activities during this time such as trips to the new Maayan in the Dagan, petting zoo & more surprises! EARLY & AFTER CARE ~Early drop off option: 7:45-8:45am: 25₪/day per child. ~Tzaharon/After care option 2:30-3:30pm: 25₪/day per child. Please note: Early care and after care is available with prior arrangement only for safety reasons. RATES:* Week 1- 850₪ Week 2- 850₪ Week 3- 850₪ Full summer: ₪2350₪ (reflects a 200₪ discount for all three weeks!) *2+ sibling discount: 2250₪/sibling *We have a limited scholarship fund available for those unable to pay the entire amount for camp. *Special Discounts Available for Active Miluim & Single parent Families If you would like to request a discount please email [email protected] Please consider contributing towards the scholarship fund so that the Gan Izzy experience can be available for every child. www.chabadofefrat.com/partner REGISTRATION FEE In order to hold your child/ren's spot in camp please send a non-refundable ₪250 registration fee after registering. This will be deducted from your total payment for camp. Payment methods will appear in the confirmation email sent after registration. אנא קראו עד הסוף לפני מילוי הטופס: תאריכים: עדכון: שבוע 1 מלא לקבוצת טייני טוטס (שלחו לנו מייל להירשם לרשימת ההמתנה!) יום שני 2 באוגוסט – יום חמישי 20 באוגוסט הקעמפ יתקיים בין השעות 8:45-14:30 עם אפשרות להשגחה מוקדמת ואחר הצהריים (פרטים בהמשך) שבוע ראשון: (5 ימים) יום ראשון 2 באוגוסט עד יום חמישי 6 באוגוסט שבוע שני: (5 ימים) יום ראשון 9 באוגוסט עד יום חמישי 13 באוגוסט שבוע שלישי: (5 ימים) יום ראשון 16 באוגוסט עד יום חמישי 20 באוגוסט גילאים וחלוקה: טייני טוטס בנים ובנות עולים לגן 4 שיש להם אח/ות בקבוצות הבוגרות. קבוצת טייני טוטס תתקיים בהעומר 29.1 עקב ביקוש גבוה, בשלב זה מתקבלים רק ילדים שיש להם אח/ות בקבוצה בוגרת. קידי קעמפ: בנים ובנות בגילאי עולים לגן חובה קבוצת הגדולים (יוצאים לטיולים): בנים ובנות עולים לכיתא א ומעלה קבוצת בנות נוער: בנות בגילאי 10-12 מיקום הקעמפ יתקיים במתנ"ס בית ספר אלומים, רחוב הקציר 5, דגן. המתחם כולל 6 חדרים, מגרש כדורסל, מקלט גדול ושטח חיצוני רחב. ארוחת צהריים עקב העלייה הכללית במחירים, אנו משתדלים לשמור על דמי הקעמפ במחיר נוח ככל האפשר. דרך אחת להשיג זאת היא לאפשר להורים לשלוח ארוחת צהריים מהבית. הרשמה לארוחת צהריים חמה כאן בתשלום נוסף. ארוחת עשר חייבת להישלח מהבית ואינה מסופקת בקעמפ. טיולים: ילדים העולים לכתה א' ומעלה ייצאו לטיולים מרגשים 1-2 פעמים בשבוע! הקבוצות הצעירות יהנו מפעילויות מיוחדות באותו הזמן. השגחה מוקדמת ואחר הצהריים ~ אפשרות השגחה מוקדמת: 7:45-8:45: ₪25 ליום לילד. ~ אפשרות השגחת צהרון: 14:30-15:30: ₪25 ליום לילד. יש לשים לב: השגחה מוקדמת ואחר הצהריים זמינה רק בהרשמה מראש מטעמי בטיחות. מחירים:* שבוע 1 - 850₪ שבוע 2 - 850₪ שבוע 3 - 850₪ כל הקיץ - 2350₪ (כולל הנחה של ₪200 עבור שלושת השבועות!) *הנחת אחים: 2250₪ *ישנה קרן מלגות מוגבלת למי שאינו יכול לשלם את מלוא הסכום. אם ברצונכם לבקש הנחה, אנא פנו לרב שלוימי במייל: [email protected]. אנא שקלו לתרום לקרן המלגות כדי לאפשר את חוויית גן עזי לכל ילד. www.chabadofefrat.com/partner דמי הרשמה כדי לשמור מקום לילדכם, יש לשלוח דמי הרשמה בסך ₪250 (לא ניתן להחזיר) לאחר ההרשמה. סכום זה יוקז מהתשלום הכולל לקעמפ. אמצעי התשלום יופיעו במייל האישור שיישלח לאחר ההרשמה. REGISTER HERE! Parents Information Mother's Full Name* Mother's Teudat Zehut* Mother's date of birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Mother's Phone Number* Area Code Phone Number Mother's E-mail* Father's Full Name* Father's date of birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Father's Phone Number* Area Code Phone Number Father's E-mail* Will the campers father be in active duty (miluim) during camp? YesNoUnsure Preferred contact number* Area Code Phone Number Prefered contact E-mail* Parents Marital Status:* MarriedSeparated/DivorcedSingle Parent Home Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Which neigborhood are you from? Dagan TamarZayitDekelGefenRimon/TeenaOther Yishuv Please list anyone who may pick up your child/ren other than his/her parents: Child's Information 1. Child's Full Name* 2. Child's Teudat Zehut* 3. Child's Hebrew Name* 4.Child's Gender:* Please SelectMaleFemale 5. Child's Birth Date* 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month20232022202120202019201820172016201520142013201220112010 Year 6. Child's Hebrew Birthday month:* תשריחשוןכסלוטבתשבטאדרניסןאיירסיוןתמוזאבאלול https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 7. Child's Hebrew Birthday day:* אבגדהוזחטייאיביגידטוטזיזיחיטככאכבכגכדכהכוכזכחכטל https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 8. Child's age* Girl ages 4-12 Boys ages 4-8 9. Child's upcoming grade* גן חובהגן 4כיתה אכיתה בכיתה גכיתה דכיתה הכיתה וכיתה זכיתה ח Sessions Week One runs from August 2-6 Week Two runs from August 9-13 Week Three runs from August 16-20 10. For which weeks will your child be joining?* Week 1, Week 2, Week 3(discounted)Week 1Week 2Week 3 11. I would like to sign-up for Early drop-off for: Please select all that apply Week 1Week 2Week 3 12. I would like to sign-up for late pick-up for: Please select all that apply Week 1Week 2Week 3 Health Declaration 13. I hereby declare:* I have no knowledge of any health limitations that would prevent my child from participating in the activities at campMy child has health limitations which will prevent him from participating in some or all of camp activities. In order to complete your registration it will be necessary to fill out a complete health declaration form. After submitting this registration form please reach out to Rabbi Shloime at [email protected] to receive the health declaration form to complete your child's registration. 14. Kupat Cholim:* 15. Does your child have allergies/sensitivities?* YesNo 16. Please share the details of your child's allergy/s and or sensitivities: 17. Does your child take any medications?* YesNo 18. Please share the details of your child's medications and how it is administered: 19. Is your child capable of administering his/her medications on his/her own?(inhaler, injection kit, treatment kit…) YesNo 20. Please specify: 21. How well can your child swim?* My child can not swimMy child is a weak swimmerMy child is a moderate swimmerMy child is a strong swimmer 22. Does your child have any behavioral challenges whether diagnosed or not?* Please list any diagnoses your child has such as ADHD, Autism, Behavior challenges, social anxiety, etc. YesNo 23. Please share the details of your child's behavioral challenges and any effective methods of overcoming it/them: Please share examples of your child's behavioural challenges such as emotional dysregulation, difficulty sitting, tantrums, walking away, etc. And please share examples and ideas of effective methods to deal with the behaviour. (for example: going outside to run around, sticker chart etc) **Additional Support Policy: Camp Gan Izzy reserves the right to require a child to attend with a shadow/aide if their needs require significant one-on-one attention or impact the supervision of the group.* I have read and agree to this policy. 24. Would you like to register another child?* YesNo Second Child Information 25. Second Child's Full Name* 26.Second Child's Teudat Zehut* 27.Second Child's Hebrew Name 28. Second Child's Gender:* Please SelectMaleFemale 29. Second Child's Birth Date* 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month20232022202120202019201820172016201520142013201220112010 Year 30. Second Child's Hebrew Birthday month:* תשריחשוןכסלוטבתשבטאדרניסןאיירסיוןתמוזאבאלול https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 31. Second Child's Hebrew Birthday day:* אבגדהוזחטייאיביגידטוטזיזיחיטככאכבכגכדכהכוכזכחכטל https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 32. Second Child's age* Girl ages 4-12 Boys ages 4-8 33. Second Child's upcoming grade* גן חובהגן 4כיתה אכיתה בכיתה גכיתה דכיתה הכיתה וכיתה זכיתה ח Sessions Week One runs from August 2-6 Week Two runs from August 9-13 Week Three runs from August 16-20 34. For which weeks will your child be joining?* Please select all that apply Week 1, Week 2, Week 3(discounted)Week 1Week 2Week 3 35. I would like to sign-up for Early drop-off for: Please select all that apply Week 1Week 2Week 3 36. I would like to sign up for late pick-up for: Please select all that apply Week 1Week 2Week 3 Health Declaration 37. I hereby declare:* I have no knowledge of any health limitations that would prevent my child from participating in the activities at campMy child has health limitations which will prevent him from participating in some or all of camp activities. In order to complete your registration it will be necessary to fill out a complete health declaration form. After submitting this registration form please reach out to Rabbi Shloime at [email protected] to receive the health declaration form to complete your child's registration. 38. Kupat Cholim:* 39. Does your child have allergies/sensitivities?* YesNo 40. Please share the details of your child's allergy/s and or sensitivities: 41. Does your child take any medications?* YesNo 42. Please share the details of your child's medications and how it is administered: 43. Is your child capable of administering his/her medications on his/her own?(inhaler, injection kit, treatment kit…) YesNo 44. Please specify: 45. How well can your child swim?* My child can not swimMy child is a weak swimmerMy child is a moderate swimmerMy child is a strong swimmer 46. Does your child have any behavioral challenges whether diagnosed or not?* Please list any diagnoses your child has such as ADHD, Autism, Behavior challenges, social anxiety, etc. YesNo 47. Please share the details of your child's behavioral challenges and any effective methods of overcoming it/them: Please share examples of your child's behavioural challenges such as emotional dysregulation, difficulty sitting, tantrums, walking away, etc. And please share examples and ideas of effective methods to deal with the behaviour. (for example: going outside to run around, sticker chart etc) 48. Would you like to register another child?* YesNo Third Child Information 50. Third Child's Full Name* 51. Third Child's Teudat Zehut* 52. Third Child's Hebrew Name 53. Third Child's Gender:* Please SelectMaleFemale 54. Third Child's Birth Date* 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month20232022202120202019201820172016201520142013201220112010 Year 55.Third. Child's Hebrew Birthday month:* תשריחשוןכסלוטבתשבטאדרניסןאיירסיוןתמוזאבאלול https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 56. Third Child's Hebrew Birthday day:* אבגדהוזחטייאיביגידטוטזיזיחיטככאכבכגכדכהכוכזכחכטל https://www.chabad.org/calendar/birthday_cdo/aid/6228/jewish/Jewish-Birthday-Calculator.htm 57. Third Child's age* Girl ages 4-12 Boys ages 4-8 58. Third Child's upcoming grade* גן חובהגן 4כיתה אכיתה בכיתה גכיתה דכיתה הכיתה וכיתה זכיתה ח Sessions Week One runs from August 2-6 Week Two runs from August 9-13 Week Three runs from August 16-20 59. For which weeks will your child be joining?* Please select all that apply Week 1, Week 2, Week 3(discounted)Week 1Week 2Week 3 60. I would like to sign-up for Early drop-off for: Please select all that apply Week 1Week 2Week 3 61. I would like to sign-up for late pick up for: Please select all that apply Week 1Week 2Week 3 Health Declaration 62. I hereby declare:* I have no knowledge of any health limitations that would prevent my child from participating in the activities at campMy child has health limitations which will prevent him from participating in some or all of camp activities. In order to complete your registration it will be necessary to fill out a complete health declaration form. After submitting this registration form please reach out to Rabbi Shloime at [email protected] to receive the health declaration form to complete your child's registration. 63. Kupat Cholim:* 64. Does your child have allergies/sensitivities?* YesNo 65. Please share the details of your child's allergy/s and or sensitivities: 66. Does your child take any medications?* YesNo 67. Please share the details of your child's medications and how it is administered: 68. Is your child capable of administering his/her medications on his/her own?(inhaler, injection kit, treatment kit…) YesNo 69. Please specify: 70. How well can your child swim?* My child can not swimMy child is a weak swimmerMy child is a moderate swimmerMy child is a strong swimmer 71. Does your child have any behavioral challenges whether diagnosed or not?* Please list any diagnoses your child has such as ADHD, Autism, Behavior challenges, social anxiety, etc. YesNo 72. Please share the details of your child's behavioral challenges and any effective methods of overcoming it/them: Please share examples of your child's behavioural challenges such as emotional dysregulation, difficulty sitting, tantrums, walking away, etc. And please share examples and ideas of effective methods to deal with the behaviour. (for example: going outside to run around, sticker chart etc) Camp T-shirt Order Form How many T-shirts would you like to order ?(30₪ per shirt) NOTE: Girls sizes 10+ will be 3/4 sleeves 1234 T-shirt 1: What size would you like to order? 4681012141618 T-Shirt 2: What size would you like to order? 4681012141618 T-Shirt 3: What size would you like to order? 4681012141618 T-shirt 4: What size would you like to order? 4681012141618 Would you like your daughters' T-shirt to be 3/4 sleeves?* YesNoNot applicable Parent’s consent to child's participation in camp activities and liability limitations : 1. I allow and consent for my child to participate in all camp activities, including trips and transportation to trips, visiting sites/attractions etc. according to the camp schedule. 2.Responsibility and liability for a child begins when he/she enters camp campus until after the days activities. 3. Any change in a child’s health or any complaints will be given in writing to the camp director. 4. The camp director reserves the right to change the program based on circumstance. 5. The camp director reserves the right to discontinue a child’s participation in camp for serious issues. 6. I consent that any property left in camp and not requested for 30 days after camp ends may be done with as the director sees fit. 7.Pictures and videos will be taken during camp activities to be sent to parents and/or used for Chabad of Efrat promotional material unless a written request is submitted to the camp director asking for a child's picture not to be sent or used in promotional material. Check Box after reading the consent form!* I have read and consent to the above Would you like to be added to a whatsapp broadcast list that will remind you of trips, activities, and special dress-up days?* YesNot at this time Questions and Comments: Total in Shekel (ignore dollar sign) ₪0.00 ILS Yes, I'd like to donate the cost of processing this transaction by adding 3% How would you like to pay?* Israeli Credit CardUS Credit CardIsraeli Bank TransferCashI will email Rabbi Shloime([email protected]) regarding a discount.OtherPaybox Payment using Paybox may be sent to Shloime at 054-730-8983. After submitting the form please go to this link to complete payment using an American Credit Card. Your registration will only be complete after payment is sent. To send the correct amount in USD please convert the Shekel amount to USD using this link. Cash Payment: After submitting your registration form, please be in touch with Rabbi Shloime (0547308983) regarding your cash payment. Thank you Bank Transfer: Please submit your form and send a bank transfer to: בית חב"ד שכונת הדגן אפרת בנק מרכנתיל סניף 734 חשבון 87176531 and send an email confirmation after payment is sent. Thank you Payment Credit Card We accept Visa, MasterCard Credit Card Number Security Code Name on Card Israel Identity Number1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Submit Clear Form Should be Empty: This page uses TLS encryption to keep your data secure.
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