~ Online Registration ~ 2015


Please fill out the form below carefully. When you press submit,
this form will be sent to our administration office.

Note: Please use a separate form for each child.

  

Camper/Parent Information
Home Address

 

 Child's Name
    Gender    M    F
 City  Date of Birth
 State Grade

Entering Sept. 2015
 Zip  School

Phone #		   Mom's Name
Hampton's #
  Mom's Work #  
Hampton's   Address   
Even if you do not receive mail here		 Mom's Cell #
  City Mom's Email
 zip   Dad's Name
   

Dad's Work #
    Dad's Cell #

    Dad's Email
       
Additional  Information
 Does your child receive any special services?, (Speech/OT etc)

Is there any information regarding your
child that you feel our camp should be aware of ?

Choose your child's specialty camp: (for 6-11 year olds) 2 hours a day, 3 afternoons. (No extra cost applies.)

 Sports camp   Theatre Camp  Gan Izzy Electives
 
Please indicate number of sessions your child will attend camp:
 
                                      Tuition - Mini Gan & Older Gan Tuition - CIT's
Counsoler's in training
Full Summer Session 7 weeks  $4,200 $1,750
1st Session 6/29-7/17 (3 weeks)  

 $1,800 

 $750
 2nd Session 7/20-8/14 (4 weeks) $2,400 $1,000
  Weekly    
1  2  3 
4  5  6  7		 $650  Enrollment in out CIT Program by Session only
   
TRANSPORTATION (not included in tuition cost)
WE WILL BE PROVIDING 2 SEPARATE AIR-CONDITIONED BUSES
FROM WESTHAMPTON AND EASTHAMPTON AREAS
No, I will not be taking advantage of CGI’s bus transportation - I will be dropping off and picking up my camper daily.
Yes, my camper will be taking advantage of CGI’s bus transportation.
 Round trip door to door transportation $175 per week (or for 2 children a total of $250)
Summer Address
 
 
Billing Information
First Name   Card type
Last Name   Card number
Total Amount   CVV Security Code      

What's this? 

 		    
Exp. Date
 
 

There are no refunds for absences, changes, withdrawal or terminations. Registration deposit is fully refundable until May 1, 2014, less a $250 Administrative Fee.
 
IMPORTANT
 
 I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.  Click Here for More
 
     
  Date of Application: