Shemesh (Summer Camp) Enrolment Form 5782

RSY-Netzer Shemesh 5782/2022 (Summer Camp) Enrolment Form

31st July - 14th August 2022 (dates vary by age group)
Thank you for applying to RSY-Netzer Shemesh 5782!

Please complete this Enrolment Form. You will need the following:
- credit card to pay a deposit
- your child/ward to read and agree to the behaviour agreement
- a current photograph of the participant
- relevant medical information, including the year of their tetanus vaccination
- GP contact details
This form will take around 30 minutes to complete.

If you wish to save your progress and resume at a later date, scroll to the bottom of the form and use the SAVE option.

Please visit our website in a new tab for the brochure, the cancellation policy and our Covid-19 FAQs.

The full balance is due by 31st May 2022.

The information you provide us with will be handled in accordance with our privacy policy https://www.reformjudaism.org.uk/privacy-policy/. For your child/ward’s benefit, it is important that all information is included as it will allow us to support your child during Shemesh. We are able to accommodate a variety of additional needs but withholding medical, educational, wellbeing or other information could lead to your child being withdrawn from the event.

If you have any problems whilst filling out the Enrolment Form, please contact Alyson Joseph on 020 8349 5666 or ajoseph@rjuk.org
RSY-Netzer's 'Brit Kehilla'

A Code of Conduct for Young People. Please read through with the participant and tick the box to confirm that both yourself and the participant have read and agreed to the Brit Kehilla.
RSY-Netzer strives to run programmes which are fun, educational and fulfilling, and which encourage young people to take responsibility for themselves, their words and actions. As a general rule, we very rarely have problems on our events, but nevertheless operate the following strict code of conduct to ensure that no individual or group damages the experience of others.

Participants are expected to:

1. Behave in a responsible manner as defined by camp staff.
2. Participate in all educational and social activities.
3. Treat others and staff with care and respect.
4. Treat RSY-Netzer’s and the camp site’s property with care and respect.

Participants can expect to:

1. Be treated fairly and with respect.
2. Have an organised programme of activities run for them.
3. Be within a safe environment.
4. Have any complaints taken seriously and responded to appropriately by RSY-Netzer staff.

General Rules:
1. We expect participants to attend and engage fully in all activities.
2. Participants are not to engage in any anti-social behaviour (including stealing, bullying, vandalism, disruptive non-participation or anything deemed to be irresponsible).
3. Participants are not to use alcohol, non-prescribed drugs or any substance open to misuse (eg glue, lighter fuel, artificial stimulants, etc.)
4. Participants are not allowed to smoke or use e-cigarettes on any of our events.
5. No participants may take an unauthorised absence from the site.
6. We expect participants to fully comply with Covid precautions as will be communicated before and during camp, which may include, but is not limited to, regular testing, temperature checks, hand washing and mask-wearing.
Discipline Procedure - Three strikes and out

RSY-Netzer staff strive to discuss with an individual all behaviours observed that are outside of the accepted norms in an attempt to help young people understand the implications of the behaviour and therefore change those behaviours. Sometimes there is a need to take more affirmative action, in which case all RSY-Netzer staff have been instructed to operate according to the following disciplinary procedure:

1. Any participant caught violating any of the above rules will be issued with a first warning. At this point, they will be asked to contact their parent/guardian to inform them of this fact. They will also engage in a small period of reflection and conversation as an opportunity for reconciliation facilitated by the Wellbeing Officer and Rashimot (heads of camp) and a positive, constructive action e.g. cleaning or leading grace after meals.

2. Any participant caught violating any of the above rules for a second time will be issued a second warning. A professional member of the team will contact the parent/guardian to inform them of this fact, discuss means of resolving the issue, and request that they make contingency plans should an incident occur again. The participant will engage in a longer period of reflection and conversation as an opportunity for reconciliation and a negative consequence e.g. missing a fun activity or free time.

3. Any participant caught violating any of the above rules for a third time will, following a period of reflection, be sent home at their own cost and without refund with no further warning. Logistical arrangements will be made between the parent/guardian and the RSY-Netzer staff.

Please be aware that single strikes may be skipped over if the participant has behaved in a manner deemed more severe than would be considered to receive the next strike (e.g. a participant may be instantly given a second strike and not a first strike if their behaviour is deemed to have been severe enough, or a third strike may be given if the participant was previously on a first strike).

In the event that a programme participant is found engaged in illegal activity or anything deemed particularly serious or dangerous by RSY-Netzer staff, they will immediately activate strike Three. The participant will be sent home without warning and at their family's own cost.

Being sent home from an RSY-Netzer event will affect your chances of being accepted onto future programmes. If this scenario occurs the cost of travel will be incurred by the parents/guardians of the participant.

Complaints Procedure
If any participant feels that they have been the subject of unfair treatment by any member of staff or volunteer leader they have the right to submit a formal letter of complaint to the Chief Operating Officer. Any complaints will be dealt with seriously and promptly. In the event that you are not satisfied with the response, you may pursue your complaint with the Chair of the Board of Reform Judaism to achieve a satisfactory resolution. The Chief Operating Officer can be contacted at the Sternberg Centre or at Ddoobay@rjuk.org

Love your neighbour as yourself וְאָהַבְתָּ לְרֵעֲךָ כָּמוֹךָ

RSY-Netzer is committed to listening to all concerns and complaints, however, we will not continue conversations with anyone who communicates with us inappropriately, in an intimidating or threatening way, by phone, email, on social media or in person.
I and my child/ward have read and agree to the full Brit Kehilla *

My child/ward and I agree to the Brit Kehilla
Participant's Details

Please enter the participant's details. Parent/Guardian's details will be entered on a later page.
Participant's Legal Name *

First Name Last Name
Participant's Preferred Name
Which Shemesh camp are you applying for? *

Briyah (school years 5 & 6/P6 & P7) Shachar (school year 7/S1) Emunah (school year 8/S2) Reut (school year 9/S3) Atid (school year 10/S4)
To help our staff identify your child/ward and ensure their welfare, please upload a passport style image of your child/ward. This image will not be used for any other purpose. Please upload the image in the form of a jpeg, jpg or png (Max size 4MB).
Participant's Photo *

Cancel of
Date of Birth *

Day Month Year
Age as of 31st July 2022 *
Sex
Sex *
Gender (if different to sex)
Pronouns *

He/Him/His She/Her/Hers They/Them/Theirs Other
Participant's Address *

Street Address

Street Address Line 2

City County

Postal Code Country
School Name *
Is the participant a Reform synagogue member? *

Yes No
If yes, which synagogue *
If the participant is a member at a synagogue which is not Reform, which synagogue?
Participant's First Language *
Travel to Event

Travel from communities outside London will be based on demand: please tick here if you would prefer to travel from the North.
I prefer to travel from the North *

Yes No
Every year RSY-Netzer has a new camp t-shirt, please tell us the size of t-shirt your child/ward will want in the summer. Please note these sizes are adult clothing sizes.
T-shirt size (adult sizes) *
Parent/Guardian Details

Parent/Guardian 1 is the primary contact. This person will be responsible for settling payment and receiving event information.
Parent/Guardian 1
Parent/Guardian 1's Name *

First Name Last Name
Parent/Guardian 1's Relationship to Participant *
Parent/Guardian 1's Email *
example@example.com
Parent/Guardian 1's Mobile Number *
Parent/Guardian 1's Home Phone Number
Parent/Guardian 1's Work Phone Number
Parent/Guardian 2
Parent/Guardian 2's Name

First Name Last Name
Parent/Guardian 2's Relationship to Participant
Parent/Guardian 2's Email
example@example.com
Parent/Guardian 2's Mobile Phone Number
Dorm Sharing
Is this the participant's first time on an RSY-Netzer event? *

Yes No
Do they know fewer than 5 people? *

Yes No
In no particular order, please list up to 3 other participants, that your child/ward would like to share a room with. We will give each participant ONE person in their room that they have named. If you put down fewer than 2 people, we may need to contact you to discuss dorm allocations further.

Please note we do not take the order that you have put these names down into account when allocating rooms.
Participant A)
Participant B)
Participant C)
Is there a serious ongoing concern with another participant where you have involved the school, the police or any other professional and which will require them NOT to share a dorm, or be in a group together? If yes, please provide us with the relevant details.
Is there a serious ongoing concern with another participant? *

Yes No
Name of participant with whom there is a concern *
Please explain the concern further *

0/250
Medical and Wellbeing

Here you will be able to enter the medical and wellbeing details of the participant - please be honest so that we can appropriately support them during camp. Please have the date of your child/ward's last anti-tetanus injection/booster readily available, along with their doctor's and emergency contact's details. If anything changes relating to the medical or wellbeing information before Shemesh begins it is your responsibility to advise us in writing beforehand. RSY-Netzer reserves the right to refuse any applicant.
Wellbeing Details
Is this the first time the participant has been away from home unaccompanied by a family member for more than 2 nights? *

Yes No
If yes, please tell us if there is any information we need to know to support your child on a longer residential event. *
Has the participant ever been excluded from school or a summer camp? *

Yes No
If they have been excluded, please tell us more *
Has the participant experienced any difficulties at school or in any other social environments, including on social media/online? (e.g. bullying) *

Yes No
If they have experienced difficulties, please tell us more *
Have there been concerns about the participant's behaviour? *

Yes No
If there have been concerns about behaviour, please tell us more *
Are there any comments on family health/background or any other health/medical issues that you think would be useful for us to know about? (e.g. divorce, adoption, bereavement, emotional difficulties, additional learning needs etc) *

Yes No
If there are comments on health/background, please tell us more *
Is the participant known to any other professional? (e.g. social worker, therapist, psychologist or SENDCO) *

Yes No
If they are known to a professional, please tell us more *
Photography Policy

RSY-Netzer operates an ‘Opt-in’ System for photographs of your child/ward to be used in future publicity and social media, etc.
I opt-in my child/ward to the Photography Policy *

Yes No
Swimming Ability

RSY-Netzer aims to be as inclusive as possible and allow for everyone on our events to take part in all activities. Please indicate the level of confidence your child/ward has in the water so we can accommodate for all abilities. Please note that not all of our sites have a swimming pool.
My child/ward... *

Is a strong swimmer Is confident in water Is nervous in water (but can swim) Cannot swim
Dietary Requirements

RSY-Netzer runs a vegetarian camp with no fish, in line with our ideological commitment to Jewish ethical eating.
Does the participant require any special medical diet? e.g. (vegan, coeliac etc) *

Yes No
If they do require a special medical diet, please give more information *

0/250
Does the participant have any specific food allergies or intolerances? *

Yes No
If they do have a specific food allergy or intolerance, please give more information *

0/250
Medical Details
Doctor's (or Surgery) Name *
Surgery Telephone Number *
Last Anti-tetanus injection/booster *

Day Month Year
Date
Date of first Covid Vaccination

Day Month Year
Date
Date of second Covid Vaccination

Day Month Year
Date
Please give details of any surgical operations that the participant has undergone in the last 3 years.
Please give details of any other medical or mental health conditions suffered by the participant, presently or in the past (e.g. eating disorders, self-harm, compulsive-behaviour) - please be honest so that we can appropriately support your child/ward during camp.
Please tick to confirm that you are happy with us giving your child/ward the following non-prescription medication if the need arises. *

Antihistamine Antiseptic cream Antiseptic wipes Diarrhoea relief Ibuprofen Indigestion relief Paracetamol Plasters Throat lozenges None Other

Regular Prescriptive Medicine - Please list (e.g. inhalers)

	Medicine Name	Reason for Taking	Dosage/Frequency
1
2
3
4
5

Does the participant suffer from any of the following? Please tick all that apply *

Allergies Asthma Bed Wetting Diabetes Fits/Epilepsy Migraines Night Terrors None Recurrent Infections, Ears, Nose and Throat Severe Periods Sleep Talking Sleep Walking Sleeplessness Travel Sickness Other
Does the participant carry an EpiPen? *

Yes No
If you have answered "Yes" to any of the above, please give more information
If you have an allergy plan, please upload it below:

Cancel of
Is there any more information that you would like us to know?
COVID-19 Testing and Isolation
In early July, we will update our guidance and require all participants and parents/guardians to sign a COVID-19 agreement and follow our most up to date COVID-19 policy which could include them having regular Lateral Flow and/or PCR testing, temperature checks and being in supervised isolation if required by on-site medical staff. *

I consent to the above
Emergency Contact

Please give contact details of someone other than the parent/guardian that we can contact if we were unable to reach the parent/guardian. It is important that you notify this person that they are an emergency contact and that they need to be in the UK, and contactable during the entire event period.
Emergency Contact's Name *

First Name Last Name
Relationship to Participant *
Emergency Contact's Home Phone
Emergency Contacts Mobile Phone *
Emergency Contact's Email *
example@example.com
Cancellation and Insurance

Please read all of the following carefully.
Cancellation Policy

If you wish to cancel your place on Shemesh, you must contact: ajoseph@rjuk.org, in writing.
Payment

Please read the following carefully.
Applications will remain open, subject to availability.

Applications after 31st May you will be required to pay the full price, in order to submit the form.
Does the participant have a sibling on another RSY-Netzer summer event *

Yes No
Names of each sibling participating on other summer events. *
Financial Assistance

Financial Assistance is available to enable more people to have the opportunity to take part in RSY-Netzer events. The Movement for Reform Judaism works hard to provide funds from a dedicated Financial Assistance Fund. We are sorry that we cannot accept late applications as once our funds have been allocated it is then closed for the year. Any request made after the deadline may therefore be unsuccessful and so we suggest you apply early.
I require financial assistance *

Yes No
As you would like to apply for financial assistance, please complete the bursary form which will be emailed to you following completion of this enrolment form.

The deadline for Financial Assistance applications is strictly 15th April 2022. It is better to send in an incomplete application (eg. with payslips to follow) than to submit it late.

If you would like more information please contact Alyson Joseph on AJoseph@rjuk.org or 020 8349 5666
We are aware that for some families, the cost of the full deposit may be too high to pay upfront today. However, we require a minimum deposit of £100 to be paid on the completion of this form.
I am able to pay: *

£500.00 - Full deposit £100.00 - Minimum deposit
Please ensure you fill in the correct details below to make payment. If the details entered below are incorrect, you may need to complete the form again to submit your application.
Billing Email *
example@example.com
Billing Address *

Street Address

Street Address Line 2

City County

Postal Code/Zip Code Country
Payment Selection
If you wish to pay the full cost of camp, please tick the deposit option plus the full price applicable and your payment will be calculated accordingly.

We would be grateful if you are able to donate to the RSY-Netzer bursary fund; it is with your help that participants that would otherwise be unable to attend our events can do so.
Date to hide Earlybird

Day Month Year
Date to require full payment

Day Month Year
Date
Today's Date

Day Month Year
Deposit

£500.00 - Deposit ONLY
Full Price - Reform Early-Bird Special until end of 13th February

£734.00 - Early-bird Briyah (School years 5 & 6/P6 & P7) £1217.00 - Early-bird Shachar (School year 7/S1), Remunah (School years 8 & 9/S2 & S3) or Atid (School year 10/S4)
Full Price - Reform Member

£776.00 - Reform Briyah (School years 5 & 6/P6 & P7) £1259.00 - Reform Shachar (School year 7/S1), Remunah (School years 8 & 9/S2 & S3) or Atid (School year 10/S4)
Full Price - Non-Reform Member

£912.00 - Non-Reform Briyah (School years 5 & 6/P6 & P7) £1437.00 - Non-Reform Shachar (School year 7/S1), Remunah (School years 8 & 9/S2 & S3) or Atid (School year 10/S4)
Donation to RSY-Netzer's Financial Assistance Fund (in £)
Subtotal
Event type to pass to Stripe (HIDDEN)

Total to pay

GBP Shemesh 2022

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

GiftAid

Don’t forget to GiftAid your donation. If you are a UK taxpayer, you can boost your donation by 25p of Gift Aid for every £1 you donate. Please tick the box below.
Gift Aid

I am a UK taxpayer. Please treat my donation and any donations I make in future or have made in the past 4 years to The Movement for Reform Judaism as GiftAid donations. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of GiftAid claimed on all my donations in that tax year it is my responsibility to pay any difference.
Please let us know if you want to cancel this declaration, change your home address or no longer pay sufficient tax. If you are a higher taxpayer, you are also entitled to claim the difference between the basic rate which we will claim and the amount of tax you have actually paid. For further details on how you can do this, please contact your tax office.

Completion and Consent

To review your application please click 'back'
Would you like RSY-Netzer to contact you after this event? *

Yes No
Would you like us to contact you by: (Please tick all that apply)

Email Phone Post
Consent

I have read the RSY-Netzer Code of Conduct with my child/ward and they agree to abide by the terms outlined in it. I understand that any participant in breach of the Code of Conduct may be sent home, at my cost, and I have made necessary contingency plans should this eventuality occur.

I have filled out the form to the best of my knowledge and will update RSY-Netzer with any changes to the participant's medical or wellbeing information provided on the form.

I consent to RSY-Netzer notifying my Community of my application (MRJ Communities only).
I agree with the consenting paragraph *

Yes No
Parent's Name *

First Name Last Name
Signature *

Clear
Date *

Day Month Year
Date
If you have any questions, please contact Alyson Joseph on 020 8349 5666 or ajoseph@rjuk.org
Should be Empty:

RSY-Netzer Shemesh 5782/2022 (Summer Camp) Enrolment Form

RSY-Netzer's 'Brit Kehilla'

Participant's Details

Parent/Guardian Details

Dorm Sharing

Medical and Wellbeing

Cancellation and Insurance

Payment

Payment Selection

Completion and Consent