Camper Application

If you would like to enroll a child in Kiddy Camp (ages 4 and younger), please contact the office at [email protected] to ensure that there is still availability.

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

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

Kiddy Kamp is for children born 2019-2020.

Gan Izzy is for children entering Pre-1A until age 10.

Child 1*

First Name Middle Name Last Name

Birth Date*

Month Day Year

Gender*

MaleFemale

Grade entering 9/23*

School Attending*

Sessions*

Entire Summer (July 3-August 17) $1700Session One (July 3-July 28) $1050Session Two (August 1-August 17) $850

Child 2

First Name Middle Name Last Name

Birth Date

Month Day Year

Gender

MaleFemale

Grade entering 9/23

School Attending

Sessions

Entire Summer (Sibling Discount) (July 3-August 17) $1550Session One (July 3-July 28) $1050Session Two (July 31-August 17) $850

Child 3

First Name Middle Name Last Name

Birth Date

Month Day Year

Gender

MaleFemale

Grade entering 9/23

School Attending

Sessions

Entire Summer (Sibling Discount) (July 3-August 17) $1550Session One (July 3-July 28) $1050Session Two (July 31-August 17) $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

Does your child receive services during the school year? (If yes, please describe)*

Phone Number*

Area Code Phone Number

Address*

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

Mother's info*

First Name Last Name

Occupation*

Work Phone*

Area Code Phone Number

E-mail* Primary email

Cell Phone*

Area Code Phone Number

Father's info*

First Name Last Name

Occupation*

Work Phone*

Area Code Phone Number

E-mail*

Cell Phone*

Area Code Phone Number

How did you hear of us?

Marital Status*

Emergency Contact (OTHER THAN PARENT)*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship*

Pediatrician & Insurance

First Name Last Name

Phone Number

Area Code Phone Number

Insurance

Policy #

Camp's grand trip at the end of the summer is to Six Flags. (Excluding Mini Gan Izzy and Kiddy Camp) 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 Other

Special Needs or Allergies*

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

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 to disclose any behavioral help my child receives during the school year, to ensure that Camp has the ability to accomodate my child's needs.

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