Camp Registration

Parents Information:
Mother's Name:*
First Name Last Name
Mother's E-mail:*
Mother's Phone Number:*

Area Code Phone Number
Father's Name:*
First Name Last Name
Father's E-mail:*
Father's Phone Number:*

Area Code Phone Number
Emergency Contact Name*
First Name Last Name
Emergency Contact Number*

Home Address*

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

Hamptons Address*

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

Child's Info:
Child #1:
Full Name:*
First Name Last Name
Nickname/name your child prefers:*
Jewish Name:*
Birth Date:*

Month Day Year
Age*
T-shirt size:*
Grade Entering September 2026:*
School Attending:*
Mother Born Jewish?*

YesNo
Converted by whom?
Any Allergies?*

NoYes, please list all allergies below.
Allergies:
Division I am registering for:* Mini Gan: 2-4 years $800/wk Main Division: 5-9 years, CIT Division: 10-13 years $900/wk +$50 Security fee

Mini Gan IzzyMain Gan Israel DivisionCIT Division
My child is:
My child went to Preschool/daycare this past year:

YesNo
Dates Attending:* Check all that apply:

Full camp experience June 29 - July 31I would like to signup for two weeks at a time (Choose your dates below)
Signup 2 weeks minimum per child:

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for Mini Gan after care from 1:00 - 2:00 PM: $100/wk Check all that apply

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for after care from 2:00 - 3:00 PM $100/wk

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
Child #2:
Child 2 Full Name:
First Name Last Name
Nickname/name your child prefers:
Jewish Name:
Birth Date:

Month Day Year
Age
T-shirt size:
Grade Entering September 2026:
School Attending:
Mother of Child Jewish?

YesNo
Any Allergies?

NoYes, please list all allergies below.
Allergies:
Division I am registering for: Mini Gan: 2-4 years $800/wk Main Division: 5-9 years, CIT Division: 10-13 years $900/wk +$50 Security fee

Mini Gan IzzyMain Gan Israel DivisionCIT Division
My Child is:
My child went to preschool/daycare this past year:

YesNo
Dates Attending: Check all that apply:

Full camp experience June 29 - July 31I would like to signup for two weeks at a time (Choose your dates below)
Signup 2 weeks minimum per child:

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for Mini Gan after care from 1:00 - 2:00 PM: $100/wk check all that apply

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for after care from 2:00 - 3:00 PM $100/wk

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
Child #3:
Full Name:
First Name Last Name
Nickname/name your child prefers:
Jewish Name:
Birth Date:

Month Day Year
Age
T-shirt size:
Grade Entering September 2026:
School Attending:
Mother of Child Jewish?

YesNo
Any Allergies?

NoYes, please list all allergies below.
Allergies:
Division I am registering for: Mini Gan: 2-4 years $800/wk Main Division: 5-9 years, CIT Division: 10-13 years $900/wk +$50 Security fee

Mini Gan IzzyMain Gan Israel DivisionCIT Division
My Child is:
My child went to preschool/daycare this past year:

YesNo
Dates Attending: Check all that apply:

Full camp experience June 29 - July 31I would like to signup for two weeks at a time (Choose your dates below)
Signup 2 weeks minimum per child:

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for Mini Gan after care from 1:00 - 2:00 PM: $100/wk check all that apply

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
(Optional) I’d like to sign up for after care from 2:00 - 3:00 PM $100/wk

Week of June 29Week of July 6Week of July 13Week of July 20Week of July 27
I heard about CGI from:*
Payment Information:
Click here for pricing.
*

Family Registration Fee — non-refundable.
If I cancel my registration after June 1 I am obligated to pay a $500 cancellation fee.*

I commit to paying my balance.
Family registration fee due today

$0.00

Payment for registration fee

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

NO CANCELLATIONS | NO REFUNDS
Please check off all applicable information below.
Payment Options:*

I'd like to pay my total all at once.I'd like to be charged weekly.I'd like to have a conversation about financial assistance
Form of payment *

CashCheck - mailed/dropped off at 13 Woods Lane. East Hampton NY 11937Credit Card - using information aboveCredit Card - using information below
Credit Card Number:
Exp Date (MM/YYYY)
CVV (XXX(X))
Comments:
Disclaimer: Your registration will only be confirmed once we email you.

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Parents Information:

Child's Info:

Payment Information:

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