CGI UES Application 2022

Dear Parents,

Welcome to a brand new year of Camp Gan Israel! Thank you for your interest. We are so excited to once again be housed in the beautiful Moise Safra Center at 130 East 82nd Street and Chabad Upper East Side at 419 East 77th Street. Please complete the application below. Approval of application is pending review. Please email camp@chabaduppereastside.com with any questions or call 917-952-1474. Check out chabadyf.com for more information. Looking forward to an amazing Summer 2022!

Thank you!

Rabbi Moishe & Cheved Krasnjansky

Camp Gan Israel Directors

Camp Dates:

Mini Mini Gan: July 5 - August 18

Mini Gan Israel: June 27 - August 18

Gan Israel: June 28 - August 19

_____________

Mini Mini Gan

Campers ages 18 months - Young 2's

Monday-Thursday

9:30-12:30

Children must be 18 months by June 2022 to atend

Located at Chabad Upper East Side 419 E 77th St

Mini Gan Israel:

Campers ages 2 - 3 years old

Monday-Thursday

9:15-2:30 (Friday 1:00)

Children must be 2 by June 2022 to attend.

Located at Chabad Upper East Side 419 E 77th St

Gan Israel:

Campers ages 4 - 8 years old

Monday-Thursday

9:15-3:45 (Friday 1:30)

Located at Moise Safra Center 130 E 82nd St

Application Summer 2022

Child #1:

Division *

Child's Name *

First Name Last Name

Gender *

Female Male

Child's Nickname

Child's Hebrew Name

Date of Birth *

Would you like to enroll a 2nd child? *

Yes No

Child #2:

Division *

Child's Name *

First Name Last Name

Gender *

Female Male

Child's Nickname

Child's Hebrew Name

Date of Birth *

Would you like to enroll a 3rd child?

Yes No

Child #3:

Division *

Child's Name *

First Name Last Name

Gender *

Female Male

Child's Nickname

Child's Hebrew Name

Date of Birth *

Please Note: Your child must be between the ages of 2 - 8 years old by June 1st, 2022. We regret that we cannot accept children younger than that.

Parent's Home Address *

Street Address

Apartment Number

City State

Zip Code Country

Home Phone Number

Area Code Phone Number

Mother's Full Name *

First Name Last Name

Mother's Hebrew Name

Is Mother Jewish? *

Yes No Converted

Is Maternal Grandmother Jewish? *

Yes No Converted

Mother's E-mail *

Mother's Work Phone Number

Area Code Phone Number

Mother's Cell Phone Number

Area Code Phone Number

Any Conversions or Adoption (child, parent or grandparents)? *

Yes No

If yes, please attach the conversion documents.

Upload a File

Father's Full Name

First Name Last Name

Father's Hebrew Name

Is Father Jewish?

Yes No Converted

Father's Work Phone Number

Area Code Phone Number

Father's Cell Phone Number

Area Code Phone Number

Father's E-mail

Parent's Marital Status *

Are you affiliated with any Synagogue?

If Yes, Which Synagogue?

Please provide 2 family references:

Refereance name and number

Is your child currently attending school?

If Yes, Which School?

Child's School Contact Name

Child's School Phone Number

Area Code Phone Number

Are there any issues with your child that we should be aware of?

Is s/he currently receiving any services?

Notes:

How did you hear about us? *

For Child #2:

Is your child currently attending school?

If Yes, Which School?

Child's School Contact Name

Child's School Phone Number

Area Code Phone Number

Are there any issues with your child that we should be aware of?

Is s/he currently receiving any services?

Notes:

For Child #3:

Is your child currently attending school?

If Yes, Which School?

Child's School Contact Name

Child's School Phone Number

Area Code Phone Number

Are there any issues with your child that we should be aware of?

Is s/he currently receiving any services?

Notes:

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Chabad Upper East Side - Gan Israel Day Camp

Financial Agreement

Enter coupon