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Camp Gan Israel

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- Camp Registration Form 2026
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ב"ה

Out of town counselor application form

Out of Town Counselor Application Form
Apply Now for An Experience of A Lifetime!
For more info about our camp visit cgirochester.com/stafffaq
Full Legal Name
First Name Last Name
Name you are called
First Name Last Name

Address

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

Date of birth

Month Day Year
Phone Number
E-mail
School
Grade
City
Camp attended last year
Reference Name
First Name Last Name
Reference Number
Fathers Name
Name Full Hebrew Name
Fathers Phone Number
Fathers E-mail
Mothers Name
Name Full hebrew Name
Mothers Phone Number
Mothers E-mail
Are you applying with other counselors?

YesNo
If yes who?
Special talents, interests, hobbies:
Do you drive?

YesNo
If yes how long?
Are you certified in first aid?

YesNo
Are you a certified Life Guard?

YesNo
Do you have medical insurance in NY State?

YesNo
Have you applied to any other camp?

YesNo
Do you agree to abide by all the camp rules (including the highest level of Tznius and not having your phone with you during camp hours)?

YesNo
Do your have permission from your parents to apply for this camp?

YesNo
Do you watch movies?

SometimesNever
Do you do Chitas?

OccasionalyMost of the timeAlways
Please note anything that you feel we should know in considering this application:
Please email a recent picture to [email protected] with your name in the subject.
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2025 Trip Schedule

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Chabad Lubavitch Rochester NY

1037 Winton Road South Rochester, NY 14618

585-271-0330

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