Camp Gan Israel 2023 - Registration Now Open

Camp Gan Israel Registration 2023

Please allow yourself a minimum of 15 minutes to complete your registration.
Where did you hear about us?* Please specify the name of your friend that referred you to CGI
Number of children* Either use the toggle or put in a number. You can register up to 4 children in one form
Name*

Child First Name Child Last Name
Hebrew & Nickname*

First Name Nickname
Gender*

MaleFemale
Birth Date*

Month Day Year
Grade entering*
Yes I want to register for Camp Gan Israel

Camp Gan Israel
Name 2*

Child First Name Child Last Name
Hebrew & Nickname 2*

First Name Nickname
Gender 2*

MaleFemale
Birth Date 2*

Month Day Year
Grade entering 2*
Yes, I want to register for Camp Gan Israel*

Camp Gan Israel
Name 3*

Child First Name Child Last Name
Hebrew & Nickname 3*

First Name Nickname
Gender 3*

MaleFemale
Birth Date 3*

Month Day Year
Grade entering 3*
Yes, I want to register for Camp Gan Israel*

Camp Gan Israel
Name 4*

Child First Name Child Last Name
Hebrew & Nickname 4*

First Name Nickname
Gender 4*

MaleFemale
Birth Date 4*

Month Day Year
Grade entering 4*
Yes, I want to register for Camp Gan Israel*

Camp Gan Israel

Address*

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

Home Phone Number*

Area Code Phone Number
E-mail* For registration receipt
Parent/Guardian Marital Status*
Parent 1 (or Guardian) Name*

First Name Last Name
Parent 1 Type*
Parent 1 Occupation*
Parent 1 Business Phone

Area Code Phone Number
Parent 1 E-mail*
Parent 1 Cell Phone*

Area Code Phone Number
Parent 2 (or Guardian) Name*

First Name Last Name

Parent 2 Address*

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

Parent 2 Home Phone Number*

Area Code Phone Number
Parent 2 Type*
Parent 2 Occupation*
Parent 2 Business Phone

Area Code Phone Number
Parent 2 E-mail*
Parent 2 Cell Phone*

Area Code Phone Number
Are there any social or other challenges we should be aware of?*
Father's Religion*
Mother's Religion*
Is child adopted*

NoYes
Synagogue Affiliation*
1. Child may be picked up from camp by:

Name and Relationship
2. Child may be picked up from camp by:

Name and Relationship
MEDICAL AND EMERGENCY CONTACT INFORMATION
Emergency Contact Name*

First Name Last Name
Phone Number*

Area Code Phone Number

Address*

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

Relationship*
Family Physician*

First Name Last Name
Phone Number*

Area Code Phone Number
Medical Insurance Company*
Insurance Group Number
Primary Insured Policy Number*
Child Policy Number*
Child 2 Policy Number*
Child 3 Policy Number*
Child 4 Policy Number*
MEDICAL RELEASE

I hereby give consent to the administration of Camp Gan Israel to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Camp Gan Israel will undertake such decision.
Signature of Parent or Guardian*
Date & Time*

Month Day Year
at Hour Minutes
My child/ren is permitted to be given Children's Tylenol, Motrin or similar should the need arise:*

YesNo
Is your child/ren allergic to any medications?*

NoYes
Please specify medical allergies.
Is your child/ren allergic to any foods?*

NoYes
Please specify food allergies.
Is your child/ren up to date on all immunizations?*

YesNo
Does your child/ren have a medical, developmental or emotional condition that camp should be aware of?*

YesNo
Please specify condition(s).*
Camp T-shirt (one included in registration fee). Only select the quantity option if you would like to purchase additional T-shirts.
T-Shirt Size*
T-Shirt Size Child 2*
T-Shirt Size Child 3*
T-Shirt Size Child 4*
Optional: Additional CGI Swag
I would like to order the following number of additional camp shirts ($10 per each additional shirt)
Please indicate size/s*
I would like to order the following number of embroidered CGI hats ($10/cap) Child - One size fits all
I would like to order the following number of embroidered CGI hats ($10/cap) Adult - One size fits all
BACKGROUND AND DEVELOPMENTAL INFORMATION
The purpose of securing background and developmental information about your child is to help our camp staff better understand your child. Your child’s care during the day is a responsibility we share.

Please complete the following questionnaire.
Has your child had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel of RaleighNo
Has your child 2 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel of RaleighNo
Has your child 3 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel of RaleighNo
Has your child 4 had another past summer camp experience? If yes, please specify.*

Yes, Camp Gan Israel of RaleighNo
Please specify previous group experience(s) in which your child has participated.*
Please specify previous group experience(s) in which your child 2 has participated.*
Please specify previous group experience(s) in which your child 3 has participated.*
Please specify previous group experience(s) in which your child 4 has participated.*
Favorite Activity:
Child 2 Favorite Activity:
Child 3 Favorite Activity:
Child 4 Favorite Activity:
What are your child's particular strengths and talents?*
What are your child 2's particular strengths and talents?*
What are your child 3's particular strengths and talents?*
What are your child 4's particular strengths and talents?*
Please answer as accurately as possible - My child is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.
Please answer as accurately as possible - My child 2 is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.
Please answer as accurately as possible - My child 3 is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.
Please answer as accurately as possible - My child 4 is:*

Beginner - Not comfortable in water deeper than 3 ft.Intermediate - Comfortable in water deeper than 3 ft.Advanced - An excellent swimmer.
What other information is important to your child/ren's success?
TERMS AND CONDITIONS

PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Camp Gan Israel (CGI) both on and off site, trips, transportation to and from trips etc., unless I advise you otherwise in writing.

Limited Guardianship Approval: I herby consent that CGI's directors - Rabbi Menachem M Wilschanski & Mrs Brocha S Wilschanski be granted limited guardianship capabilities with regards to signing waivers on behalf of my child / children for trips specified in this years camp schedule. (I do understand that I may still be asked to fill out waivers, as not all locations accept this consent)

PAYMENT AND CANCELLATION: Payment terms are a $50.00 non-refundable deposit per camper to accompany registration. The balance is due by June 9, 2022 and is non-refundable after that date.

DISMISSAL OF CAMPER: Parent fully understands and agrees that the Camp reserves the right to dismiss, in its sole discretion, any Camper whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of the Camp or fellow campers or who violates camp rules and regulations. In the event of dismissal, tuition will be refunded on a pro-rated basis less the $50.00 registration deposit.

IMAGES, ETC.: Permission is hereby given to use in promoting the Camp and in other ventures directly relating to the Camp (i) digital, photographic and video images or likenesses of camper; audio of camper; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by camper or originating from Camp or from a Camp-related activity.

INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless JLC - Chabad of Raleigh, Sha'arei Israel, Camp Gan Israel (CGI) and its officers, servants or assignees from any liability concerning our child’s involvement in CGI and further agree that the use of any premises during the CGI camp day is made at the risk of the registrant.

I have read and agree to all of the terms and conditions in this Application Form. I am including a non-refundable $50.00 registration deposit per camper along with submission of this form. I further agree to remit the full tuition and any other fees by June 9, 2023 as per the agreed timeline of my choice on this form.
Signature of Parent or Guardian*
Date & Time*

Month Day Year
at Hour Minutes
Optional Add-ons

Programs will be determined based on demand.
Please contact me regarding* Please select all that apply

Hot Lunch ProgramBefore care (8:00am)After-care (3:30pm-5:00pm)I am not in need of any of the above as of now
VOLUNTEERING
Volunteering

I would like to volunteer during camp activities and trips.I would like to volunteer with transportation.I would like to volunteer in the camp kitchen.
COMMENTS
Comments:
PAYMENT
Your card will be charged a non-refundable $50 registration fee per camper. Upon acceptance to camp, you will be billed the full tuition amount as per your payment preference chosen below.
Weekly/Monthly Registration

Bonus Special! Sign up for all 4 weeks for $100 off!
$50$75$100
Please select which weeks your child will be attending:* When selecting all 4 weeks, be sure that is the only box you select.

Rising K-4th - Week 1 (June 26) - $335Rising K-4th - Week 2 (July 3)- $335Rising K-4th - Week 3 (July 10) - $335Rising K-4th - Week 4 (July 17) - $335Rising K-4th - All 4 Weeks - $1240 (Savings of $100)Rising 5th - 8th - Week 1 (June 26) - $360Rising 5th - 8th - Week 2 (July 3) - $360Rising 5th - 8th - Week 3 (July 10) - $360Rising 5th - 8th - Week 4 (July 17) - $360Rising 5th - 8th - All 4 Weeks - $1340 (Savings of $100)
Please select which weeks your child 2 will be attending (Price reflects 5% sibling discount):* When selecting all 4 weeks, be sure that is the only box you select.

Rising K-4th - Week 1 (June 26) - $319Rising K-4th - Week 2 (July 3)- $319Rising K-4th - Week 3 (July 10) - $319Rising K-4th - Week 4 (July 17) - $319Rising K-4th - All 4 Weeks - $1176 (Savings of $100)Rising 5th - 8th - Week 1 (June 26) - $343Rising 5th - 8th - Week 2 (July 3) - $343Rising 5th - 8th - Week 3 (July 10) - $343Rising 5th - 8th - Week 4 (July 17) - $343Rising 5th - 8th - All 4 Weeks - $1272 (Savings of $100)
Please select which weeks your child 3 will be attending (Price reflects 5% sibling discount):* When selecting all 4 weeks, be sure that is the only box you select.

Rising K-4th - Week 1 (June 26) - $319Rising K-4th - Week 2 (July 3)- $319Rising K-4th - Week 3 (July 10) - $319Rising K-4th - Week 4 (July 17) - $319Rising K-4th - All 4 Weeks - $1176 (Savings of $100)Rising 5th - 8th - Week 1 (June 26) - $328Rising 5th - 8th - Week 2 (July 3) - $343Rising 5th - 8th - Week 3 (July 10) - $343Rising 5th - 8th - Week 4 (July 17) - $343Rising 5th - 8th - All 4 Weeks - $1272 (Savings of $100)
Please select which weeks your child 4 will be attending (Price reflects 5% sibling discount):* When selecting all 4 weeks, be sure that is the only box you select.

Rising K-4th - Week 1 (June 26) - $319Rising K-4th - Week 2 (July 3)- $319Rising K-4th - Week 3 (July 10) - $319Rising K-4th - Week 4 (July 17) - $319Rising K-4th - All 4 Weeks - $1176 (Savings of $100)Rising 5th - 8th - Week 1 (June 26) - $343Rising 5th - 8th - Week 2 (July 3) - $343Rising 5th - 8th - Week 3 (July 10) - $343Rising 5th - 8th - Week 4 (July 17) - $343Rising 5th - 8th - All 4 Weeks - $1272 (Savings of $100)
Optional: Help support CGI

All donations are tax deductible!
At CGI we are committing to a healthy, fun & safe environment for all children, we do our best to make this program available at affordable rates & keep tuitions to a minimum but this does not cover our full camp budget. If you find yourself in a position to give and help others please consider one or more of these add ons:

$36 Sponsor snack for a day$54 Sponsor a child for a day in camp$180 Sponsor snack for a week$275 Sponsor a child for a week$1000 Sponsor a child for full session
Scholarship Scholarships are limited and are dependent on availability. If you are struggling to afford the full tuition please click this checkbox to discuss further options

I would like to apply for a scholarship. Please contact me.
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Please enter CVV / card security code* Write N/A if choosing check option
Please note that there is an additional 3% fee for credit card charge.
How would you like to pay? Please allow a few days for processing any and all payments

I would like to pay now in fullI would like to pay in 3 payments - Today, next month and the following month.I would like my payment to split into monthly installments (last installment is before June 9th)I would like to pay only the minimum $50 / child registration fee now. I understand that this is non refundable and is separate to camp tuition. (All payments are due by June 9th)
Please note that all applications will go through review upon submission. Please allow a few days before any charges to your card.
I double checked my total*

Yes
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Camp Gan Israel Registration 2023

MEDICAL AND EMERGENCY CONTACT INFORMATION

Camp T-shirt (one included in registration fee). Only select the quantity option if you would like to purchase additional T-shirts.

Optional: Additional CGI Swag

BACKGROUND AND DEVELOPMENTAL INFORMATION

Optional Add-ons

VOLUNTEERING

COMMENTS

PAYMENT

Weekly/Monthly Registration

Optional: Help support CGI

Please note that all applications will go through review upon submission. Please allow a few days before any charges to your card.