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.1. Child/ren’s InformationChild 1*First NameMiddle NameLast NameBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGender*MaleFemaleGrade 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) $850Child 2First NameMiddle NameLast NameBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGenderMaleFemaleGrade entering 9/22School AttendingSessionsEntire Summer (Sibling Discount) (July 5-August 18) $1450Session One (July 5-July 29) $1000Session Two (August 1-August 19) $850Child 3First NameMiddle NameLast NameBirth Date1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGenderMaleFemaleGrade entering 9/22School AttendingSessionsEntire Summer (Sibling Discount) (July 5-August 18) $1450Session One (July 5-July 29) $1000Session Two (August 1-August 19) $850If you have additional children please contact us.Are you interested in Extended Care?YesNoAre you interested in Transportation?Transportation availability is subject to location restrictionsYesNo2. Parent informationPhone Number*Area CodePhone NumberAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / 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 SaharaYemenZambiaZimbabweOtherCountryMother's info*First NameLast NameOccupation*Work Phone*Area CodePhone NumberE-mail*Primary emailCell Phone*Area CodePhone NumberFather's info*First NameLast NameOccupation*Work Phone*Area CodePhone NumberE-mail*Cell Phone*Area CodePhone NumberHow did you hear of us?MailerEmailFacebookNewspaper AdInternet SearchAttended PreviouslyOther3. Emergency InformationEmergency Contact (OTHER THAN PARENT)*First NameLast NamePhone Number*Area CodePhone NumberRelationship*Pediatrician & InsuranceFirst NameLast NamePhone NumberArea CodePhone NumberInsurancePolicy #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 attend4. Payment InformationA $150 registration fee is taken as a nonrefundable depositTotal$0.00I would like to pay today: Full amount$150.00 minimum $ Payment*Credit Card Paypal Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearPaypal has been selected. Payment will take place on the next page.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.SubmitShould be Empty: This page uses TLS encryption to keep your data secure.