RSY-Netzer Garinim (Day Camp) 5782 Enrolment Form

Application deadline: 22 July 2022

The deadline for receiving the Financial Assistance form is 15 July 2022

Please complete one form per participant

Thank you for your interest in our RSY-Netzer Garinim (day camp). On this form you will find all the information you will need to register your child/ward.

Code of Conduct - Please read through the code of conduct with the participant.

Participant Details - This is where you can enter the details of the participant who will be coming on camp. You will also be asked to upload a passport style photo of the participant (jpg., jpeg., or png. no larger than 1MB).

Parent / Guardian Details - This is where you enter the contact information for the parents/guardians and for an emergency contact.

Times, Prices and Payment options - This is where you can let us know when the participant will be attending. Please fill out the check box for our records. Here you will also find information about how to make your payment, make a donation and request financial assistance. Your child/ward's place cannot be confirmed until we receive payment.

Consent and Completion

Please note: The form and any information entered on it is secure and encrypted, including credit card details. You can see the HTTPS:// in the address bar of your browser. We do not store credit card details as these are passed securely through to our payment processor, Stripe.

Please click here for our T&Cs and COVID FAQs

If you have any problems whilst filling out this form, please contact Alyson Joseph on 020 8349 5666 or AJoseph@rjuk.org

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:

Behave in a responsible manner as defined by madrichim
Participate in all educational and social activities
Treat other movement members and madrichim with care and respect
Treat RSY-Netzer’s property with care and respect

Participants can expect to:

Be treated fairly and with respect
Have an organised programme of activities
Be within a safe environment
Have any complaints taken seriously, and responded to appropriately by RSY-Netzer madrichim.

General Rules

We expect participants to attend and engage fully in all activities.
Participants are not to engage in any anti-social behaviour (including stealing, bullying, vandalism, disruptive non-participation, or anything deemed to be irresponsible).
Participants are not allowed to leave the premises without a parent or named guardian - please inform us if someone else will be collecting your child.

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 consequences 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:

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.
Any participant caught violating any of the above rules for a second time will be issued with 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.
Any participant caught violating any of the above rules for a third time will be sent home at their own cost and without refund with no further warning or discussion. Logistical arrangements will be made between the parent/guardian and the professional camp staff.

Please Note:

In the event that a programme participant is found engaged in illegal activity or any thing deemed particularly serious or dangerous by RSY-Netzer staff; they will immediately activate sent home. The participant will be sent home without warning and at their families own cost

Being sent home from an RSY-Netzer event will affect your chances of being accepted onto future programmes.

PLEASE MAKE SURE THAT YOU OR A RELATIVE/FRIEND IS ABLE TO MAKE ARRANGEMENTS FOR THE PARTICIPANT IN THE UNLIKELY EVENT THAT THEY ARE SENT HOME.

Complaints procedure

If any participant feels that they have been the subject of unfair treatment by any member of staff or voluntary leader, they have the right to submit a formal letter of complaint to the Director of Youth, Students & Young Adults. 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 Chief Executive or Chair of the Board of The Movement for Reform Judaism.

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.

CODE OF CONDUCT DECLARATION

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

Confirmation *

Please tick to confirm you have read, understood and agree to RSY-Netzer's Code of Conduct

Participant name *

First Name Last Name

Participant preferred name

If applicable

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 1 MB).

Please select an image of your child/ward *

Date of Birth *

Day Month Year

Sex *

Pronouns *

He/Him/His She/Her/Hers They/Them/Theirs Other

Gender

School year *

School *

Home phone *

Address *

Street Address

Street Address Line 2

City County

Post Code Country

Is the participant a member of a Reform synagogue? *

If a member of a non-Reform synagogue, what synagogue? *

If yes what synagogue? *

Has the participant previously attended an RSY-Netzer event? If yes, please write the most recent event. *

Participant's first language if not English

Doctor's name *

Surgery telephone number *

Please tick to confirm you are happy with us giving your child the following non-prescription medication if the need arises. *

Antihistamine Antiseptic cream Antiseptic wipes Ibuprofen Imodium Paracetamol Plasters Strepsils Other

Extra space for more information

Last Anti-tetanus injection/booster *

Date

Please give details of any surgical operations that the participant has undergone in the last 3 years.

Has the participant ever been excluded from school or summer camp? *

Yes No

If yes, please tell us more

Has the participant experience any difficulties at school or in any other social environments? (e.g. bullying) *

Yes No

If yes, please tell us more

Have there been concerns about the participant's behaviour? *

Yes No

If yes, please tell us more

Are there any comment 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, dyslexia etc) *

Yes No

If yes, please tell us more

Is the participant known to any other professional? (e.g. social worker, therapist, psychologist or SENDCO) *

Yes No

If yes, please tell us more

DIETARY REQUIREMENTS

RSY-Netzer runs a vegetarian camp with no fish, in line with their ideological commitment to ethical eating. You will be required to provide a packed lunch for your child which is vegetarian and NUT FREE.

If you require any special medical diet, please give more information e.g. vegan, coeliac, etc.

If you have any specific food allergies/intolerances, please give more information

Refer 3 friends to sign-up for Garinim and win a free RSY-Netzer jumper!!

Just get them to tick 'From a Friend' below and enter your name!

How did you hear about RSY-Netzer Day Camp? (please tick as many that apply) *

Online / Social Media Synagogue Rabbi's sermon Youth club / cheder Someone from RSY-Netzer I always go / my family have always been From a friend Other

Name of Friend *

Parent/Guardian 1 Details

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

Full Name *

Relationship to Participant *

Mobile phone *

Work phone

E-mail *

example@example.com

If these details are the same as Participant 1, please tick the relevant box

Home phone Synagogue Address

Home phone *

Address *

Street Address

Street Address Line 2

City County

Post code Country

Synagogue

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 they need to be in the UK, and contactable during the entire event period.

Contact name *

Relationship to participant *

Home phone *

Mobile phone *

Work phone

E-mail

example@example.com

Address

Street Address

Street Address Line 2

City County

Post code Country

Our day camp runs from 9:30 - 15:30 Monday to Friday

Extended Hours 8:30 Start / 17:00 Finish

No extended afternoon hours on Friday

Reform Member Price

All 5 Days (9:30 - 15:30) - £135 per Participant

Extended morning price - £5 and Extended afternoon price - £8

Price per day (if the participant isn't attending the whole week) - £35 per Participant

Non Reform Member Price

All 5 Days (9:30 - 15:30) - £150 per Participant

Extended morning price - £5 and Extended afternoon price - £8

Price per day (if the participant isn't attending the whole week) - £40 per Participant

On the grid below, please select days and extended hours for which you would like your child to attend.

NB: Due to limitations with the form, if you want the whole week, select the "All 5 days" option to receive the discounted price; do not select individual "Regular" days. However, if you want extended hours for the whole week, they must be selected individually.

Reform

	Regular day (9:30-15:30)	Extended morning (8:30 - 9:30)	Extended afternoon (Monday-Thursday) (15:30-17:00)
Monday 1st August
Tuesday 2nd August
Wednesday 3rd August
Thursday 4th August
Friday 5th August
OR All 5 days

Non Reform

	Regular day (9:30-15:30)	Extended morning (8:30 - 9:30)	Extended afternoon (Monday-Thursday) (15:30-17:00)
Monday 1st August
Tuesday 2nd August
Wednesday 3rd August
Thursday 4th August
Friday 5th August
OR All 5 days

Camp fees (£)

Do you require financial assistance? *

Yes, I will download and fill in the form above No, I will pay now

Billing Address *

Street Address

Street Address Line 2

City County

Post code

Billing Email *

example@example.com

Are you able to support those in financial need?

RSY-Netzer needs to raise substantial amounts to provide a Financial Support Fund for our participants. If you are able to give a small donation you will help another young person to experience RSY-Netzer. If you would like to donate, please add an amount to the box below.

Thank you

Please donate to our Financial Support Fund (£)

Gift Aid

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.

I am a UK taxpayer. Please treat my donation and any donations I make in the future or have made in the past 4 years to The Movement for Reform Judaism as Gift Aid donations. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid 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.

Total amount due (£)

Total

GBP Garinim 2022

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

RSY-Netzer Privacy Policy

We take your privacy seriously and will only use your personal information, and that of your child/ren, for the purposes RSY-Netzer events (by phone, email or post). Your information will be stored on the Reform Judaism database and it will be shared within our organisation to those staff with authorised access. Your information will not be shared with any other organisation outside our own.

After Garinim (and throughout the year), we would like to keep in contact with you, and your child/ren, and send you details of other RSY-Netzer events (including, but not limited to Shemesh (summer camp), Israel Tour and Choref (winter events)). This might be by phone, email and post. If at any point you wish for your data to be removed from our database, you may request so. For any enquiries about personal data, please contact Alyson Joseph at ajoseph@rjuk.org or call 020 8349 5666. For more information on our privacy policy, please click here.

Would you like to be contacted by RSY-Netzer after Summer Garinim? *

Yes No

Would you like us to contact you by: *

Email Phone Post

Photography Policy

RSY-Netzer may take photos of participants on our events for future publicity and social media. We operate an 'Opt-in' System whereby if you agree, we may publish photos of your child on our publicity for events etc.

I opt-in to the photography policy *

Yes No

COVID-19 Waiver

I will only allow my child to attend an RSY-Netzer activity if they are Covid19 symptom-free, no raised temperature, no new, continuous cough and no change to their sense of taste or smell.

I will take my child's temperature within an hour of them attending an RSY-Netzer activity and will not bring them to the activity if it is above their normal temperature.

In the event that my child, or anyone in my household, has any Covid19 symptoms I will let RSY-Netzer know and book a test immediately.

In the event of a positive test result, I will let RSY-Netzer know immediately, contact track & trace and will isolate in accordance with Government guidelines.

I will let RSY-Netzer know if my child has been in contact with someone who has tested positive for Covid19.

Parents must understand that we cannot be held responsible if a child contracts COVID 19 during the course or develops symptoms during or after the trip.

I will ensure that I inform RSY-Netzer of any change to our family contact details and in the event that I am contacted by RSY-Netzer to collect my child due to suspected Covid19 symptoms, I will arrange for someone to collect them without delay and will arrange a test as soon as possible. I will inform RSY-Netzer regarding the test results.

Click here for our COVID-19 FAQs

Parent/Guardian Signature

Clear

COMPLETION AND CONSENT

I hereby declare that to the best of my knowledge the medical form for the participant is accurate and complete in all its details. I consent to the participant receiving basic first aid whilst on the event. In the event of a medical emergency I understand that every possible effort will be made to contact the parent/guardian or emergency contact, but should this not be possible or practical, I hereby authorise a senior member of staff to sign the "consent for operation" form for the participant should the need arise. I undertake to notify RSY-Netzer of any changes in the participants medical and/or welfare condition between the time of completing this form and the start of the event.

I have read the RSY-Netzer Code of Conduct and agree to abide by the terms outlined in it. I understand that anyone caught in breach of the Code of Conduct may be sent home, and I have made necessary contingency plans should this eventuality occur.

Parent / Guardian Full Name *

First Name Last Name

Date of completion

Day Month Year

Parent/ Guardian Signature *

Clear

RSY-Netzer Garinim (Day Camp) @ Sha'arei Tsedek Reform Synagogue

RSY-Netzer's Brit Kehila - A Code of Conduct for young people

Participant Details

Medical and Welfare Form

Parent/Guardian Information

Times, Prices and Selection

Non Reform Member Price

On the grid below, please select days and extended hours for which you would like your child to attend.

NB: Due to limitations with the form, if you want the whole week, select the "All 5 days" option to receive the discounted price; do not select individual "Regular" days. However, if you want extended hours for the whole week, they must be selected individually.

Gift Aid

Payment

Completion and Consent

RSY-Netzer Privacy Policy

Photography Policy