Camper Application

If you have any questions or comments, please feel free to reach out to Rabbi Mendy at [email protected]

Early bird discount applies until March 25.

Sibling discount applies to additional child/ren registering for the entire summer and cannot be combined with the early bird discount.

Child 1*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Grade entering 9/22*

School Attending*

Sessions*

Entire Summer (July 5-August 18) $1600 Early Bird $1500Session One (July 5-July 29) $1000Session Two (August 1-August 18) $850

Child 2

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Grade entering 9/22

School Attending

Sessions

Entire Summer (Sibling Discount) (July 5-August 18) $1450Session One (July 5-July 29) $1000Session Two (August 1-August 19) $850

Child 3

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Grade entering 9/22

School Attending

Sessions

Entire Summer (Sibling Discount) (July 5-August 18) $1450Session One (July 5-July 29) $1000Session Two (August 1-August 19) $850

If you have additional children please contact us.

Are you interested in Extended Care?

Are you interested in Transportation?Transportation availability is subject to location restrictions

Phone Number*

Area CodePhone Number

Address*

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

Mother's info*

First NameLast Name

Occupation*

Work Phone*

Area CodePhone Number

E-mail*Primary email

Cell Phone*

Area CodePhone Number

Father's info*

First NameLast Name

Occupation*

Work Phone*

Area CodePhone Number

E-mail*

Cell Phone*

Area CodePhone Number

How did you hear of us?

Emergency Contact (OTHER THAN PARENT)*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Pediatrician & Insurance

First NameLast Name

Phone Number

Area CodePhone Number

Insurance

Policy #

Camp's grand trip at the end of the summer is to Six Flags. Does your child have a season pass or would you like to purchase a ticket with camp?*

Season PassPurchase ticket with camp($45 will be added to your invoice)Will not attend

A $150 registration fee is taken as a nonrefundable deposit

Total

$0.00

I would like to pay today: Full amount$150.00 minimum $

Payment*

Credit Card Paypal

Special Needs or Allergies*

Please contact the Camp office for scholarship opportunities or special requests.

I UNDERSTAND THAT MY CHILD'S ENROLLMENT IN CAMP IS CONTINGENT ON COVID-19 PROTOCOLS AND PROCEDURES
I grant permission for my child to participate in all camp activities, including swimming and trips away from camp grounds (dates and destinations to be provided at a later date).

I understand that if my application is not filled out completely or the required payments are not enclosed, my application will not be processed and will be returned.

I agree that my child may be photographed, and their pictures may be used in future camp promotional materials, including, but not limited to the brochure and the CGI website.

No camper will be permitted into camp without all forms completed (including medical and application) and all financial obligations satisfied.

CGI is not responsible for personal property brought to camp.

If the Camper’s conduct is harmful to the best interests of CGI Day Camp, the Camper may be dismissed at the sole discretion of the Director with no refund nor reduction of fee.

I will pay half of my child’s tuition no later than June 30 and the remainder by July 30.

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information