CGI - Registration Form - Chabad Lubavitch of Wyoming

How many children will you be registering?*

Full Name*

First Name Last Name

Full Hebrew Name

Age as of June 30, 2024*

Birth Date*

Month Day Year

Hebrew Birthday*

Gender*

FemaleMale

School Attending*

Grade Level*

Previous Summer Camp Experience?*

YesNo

Do You Have Friends Attending Camp Gan Israel?*

YesNo

If so, who?

Please select your program of choice. 1 Mini Session consists of 2 weeks - Monday through Friday

Program of choice* Come for the whole Mini Session and pay ONLY $550 per session ($100 Discount)

Mini sessionWeeklyDaily

Which Mini Session will your child attend? ($550 per mini session)

Mini Session #1 (July 15 - 26)Mini Session #2 (August 5 - 16)

Weekly ($300 per week)

Week 1 (July 15 - 19)Week 2 (July 22 - 26)Week 3 (August 5 - 9)Week 4 (August 12 - 16)

Daily ($65 per day) Please indicate the number of days the child will be attending.

Please list the specific dates of attendance below:

Full Name*

First Name Last Name

Full Hebrew Name*

Age as of June 30, 2024*

Birth Date*

Month Day Year

Hebrew Birthday*

Gender*

FemaleMale

School Attending*

Grade Level*

Previous Summer Camp Experience?*

YesNo

Do You Have Friends Attending Camp Gan Israel?*

YesNo

If so, who?

Please select your program of choice. 1 Mini Session consists of 2 weeks - Monday through Friday

Program of choice* Come for the whole Mini Session and pay ONLY $550 per session ($100 Discount)

Mini sessionWeeklyDaily

Which Mini Session will your child attend? ($550 per mini session)

Mini Session #1 (July 15 - 26)Mini Session #2 (August 5 - 16)

Weekly ($300 per week)

Week 1 (July 15 - 19)Week 2 (July 22 - 26)Week 3 (August 5 - 9)Week 4 (August 12 - 16)

Daily ($65 per day) Please indicate the number of days the child will be attending.

Please list the specific dates of attendance below:

Full Name*

First Name Last Name

Full Hebrew Name*

Age as of June 30, 2024*

Birth Date*

Month Day Year

Hebrew Birthday*

Gender*

FemaleMale

School Attending*

Grade Level*

Previous Summer Camp Experience?*

YesNo

Do You Have Friends Attending Camp Gan Israel?*

YesNo

If so, who?

Please select your program of choice. 1 Mini Session consists of 2 weeks - Monday through Friday

Program of choice* Come for the whole Mini Session and pay ONLY $550 per session ($100 Discount)

Mini sessionWeeklyDaily

Which Mini Session will your child attend? ($550 per mini session)

Mini Session #1 (July 15 - 26)Mini Session #2 (August 5 - 16)

Weekly ($300 per week)

Week 1 (July 15 - 19)Week 2 (July 22 - 26)Week 3 (August 5 - 9)Week 4 (August 12 - 16)

Daily ($65 per day) Please indicate the number of days the child will be attending.

Please list the specific dates of attendance below:

Mother's Full Name*

First Name Last Name

Mother's Full Hebrew Name (if applicable)

Mother's Religious Affiliation*

Father's Full Name*

First Name Last Name

Father's Full Hebrew Name (if applicable)

Father's Religious Affiliation*

Parent's E-mail 1*

Parent's E-mail 2

*when neither parent is unable to be reached

Emergency Contact Name*

First Name Last Name

Relationship to the Child*

Home Phone

Work Phone

Mobile Phone*

Physician or Medical Facility Name*

Phone Number*

Address

Policy Number

Is there anything special that you would like us to know about your child [allergies, specific health notes, etc]?

Would you like to sponsor a camper?*

YesNo

How much would you like to sponsor?*

$300 for one week$550 for a mini session

Total

$0.00

Payment*

Credit Card Check, Cash

Postal / Zip Code

Country

I hereby give consent for my child to participate in all activities of Camp Gan Israel, hereinafter known as CGI, both on & off site, trips, transportation to & from trips, etc., unless I advise you otherwise in writing.

Payment terms are a $60.00 non-refundable deposit to accompany registration. Registration must be in on or by June 1, 2024. The balance is due by July 1, 2024 and is non-refundable after that date.

Parent fully understands and agrees that CGI 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 CGI rules and regulations.

Permission is hereby given to use in promoting CGI and in other ventures directly relating to the CGI (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 video created by camper or originating from CGI or from a CGI related activity.

I further release and agree to indemnify and hold harmless Chabad Lubavitch of Wyoming, Chabad Jewish Center, Camp Gan Israel a/k/a CGI and its officers, servants or assigns 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.

The parent who signs the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fee.

*

I Agree with the Statements Above

Full Name*

First Name Last Name

Relationship to Child*

Date*

Month Day Year

Full Name*

First Name Last Name

Relationship to the Child*

Full Name

First Name Last Name

Relationship to the Child

I hereby give permission for my child to be transported by City Bus to and from camp, to and from field trips and to participate in all trips and camp activities. I understand that during the course of camp activities my child can be hurt. I accept the risk of possible injury and authorize any member of the Camp Gan Israel Staff to render any necessary first aid. Furthermore, in case of emergency, I hereby authorize Rabbi & Mrs. Zalman Mendelsohn, or Head Counselor to have my child taken care of by a physician or other medical person in any manner the situation calls for.

*

I Agree with the Statements Above

Child's Full Name* Child #1

First Name Last Name

Child's Full Name* Child #2

First Name Last Name

Child's Full Name* Child #3

First Name Last Name

Date*

Month Day Year

I give permission to my child/ren to go swimming at the Teton County Recreation Center swimming pool, located at 155 East Gill Avenue, Jackson, Wyoming 83001.

*

I Agree with the Statements Above

Date*

Month Day Year

I would like to receive news and updates by email

CGI - Registration Form

CAMPER INFORMATION

CHILD #1

CHILD #2

CHILD #3

PARENT INFORMATION

EMERGENCY CONTACT INFORMATION

Medical Care Information

Sponsor a Camper

CAMP TUITION - METHOD OF PAYMENT

TERMS & CONDITIONS

PARENTAL CONSENT

PAYMENT AND CANCELLATION

DISMISSAL OF CAMPER

IMAGES, ETC.

INDEMNIFY & HOLD HARMLESS

MY CHILD MAY BE PICKED UP FROM CAMP BY:

Person #1

Person #2

EMERGENCY CONSENT FORM

SUMMER 2024 SWIMMING POOL CONSENT FORM

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