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Camp Gan Israel
About
Boys
Girls
Menu
About
Boys
Girls
ABOUT
ENROLL
PARENTS
STAFF
Staff Registration – Boys
Staff Registration – Girls
TRANSPORTATION
Girls Transportation
Boys Transportation
PHOTOS
Boys
Boys 3 week program
Boys 4 week program
Boys BMD program
Girls
Girls 4 week program
Girls Teen program
Girls waitress program
CONTACT
Menu
ABOUT
ENROLL
PARENTS
STAFF
Staff Registration – Boys
Staff Registration – Girls
TRANSPORTATION
Girls Transportation
Boys Transportation
PHOTOS
Boys
Boys 3 week program
Boys 4 week program
Boys BMD program
Girls
Girls 4 week program
Girls Teen program
Girls waitress program
CONTACT
ABOUT
ENROLL
PARENTS
STAFF
Staff Registration – Boys
Staff Registration – Girls
TRANSPORTATION
Girls Transportation
Boys Transportation
PHOTOS
Boys
Boys 3 week program
Boys 4 week program
Boys BMD program
Girls
Girls 4 week program
Girls Teen program
Girls waitress program
CONTACT
Menu
ABOUT
ENROLL
PARENTS
STAFF
Staff Registration – Boys
Staff Registration – Girls
TRANSPORTATION
Girls Transportation
Boys Transportation
PHOTOS
Boys
Boys 3 week program
Boys 4 week program
Boys BMD program
Girls
Girls 4 week program
Girls Teen program
Girls waitress program
CONTACT
NAME
AGE
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Armenia
Aruba
Australia
Austria
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Bahamas
Bahrain
Bangladesh
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Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
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Bulgaria
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Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
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Chad
Chile
China
Christmas Island
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Colombia
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Congo, Republic of the
Cook Islands
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Côte d'Ivoire
Croatia
Cuba
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Cyprus
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Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
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French Southern Territories
Gabon
Gambia
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Ghana
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Madagascar
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Mali
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Mauritius
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Montserrat
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Mozambique
Myanmar
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Nauru
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Niger
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Niue
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Panama
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Spain
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Tonga
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Ukraine
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US Minor Outlying Islands
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Venezuela
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Virgin Islands, U.S.
Wallis and Futuna
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Yemen
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Zimbabwe
Country
Phone number
Mother's phone number
Email
Birthday
Birthday Hebrew
Position
SS# ( if over 18)
Work history
Training & certification
Youth group leader
Yes
No
CPR
Yes
No
Teaching experience
Yes
No
First aid
Yes
No
Camp leadership
Yes
No
Basic water safety
Yes
No
Aquatic observer
Yes
No
Waiter/waitress
Yes
No
Drama
Yes
No
Life guard
Yes
No
Singing
Yes
No
A & C
Yes
No
Have you ever been convicted of a crime other than a driving offense?
Yes
No
If yes, what offense?
Health History
Physician’s name
Phone
List allergies (if any)
Any current infectious diseases?
Yes
No
Any physical limitations?
Yes
No
If yes, list them
Taking any medication regularly?
Yes
No
If yes list them
I certify that this information is true to the best of my knowledge.
Signature
Date
REFERENCES
Please provide 3 references for yourself
It can be the rabbi of your shul, a teacher, a mashpiah, a past head counselor etc.
REFERENCE 1
Name
Position
Phone number (cell if possible)
REFERENCE 2
Name
Position
Phone number (cell if possible)
REFERENCE 3
Name
Position
Phone number (cell if possible)
ABUSE POLICY
CGI is committed to providing an environment of respect and tolerance. CGI will have zero tolerance for bullying and abuse.
Camp does NOT tolerate abuse of any kind:
No Physical Abuse
No physical or harsh punishment
No hitting, slapping, pushing, pinching, kicking etc.
No deprivation of food
No deprivation of sleep
No excessive physical demands ( 50 pushups or holding hands above the head etc.)
No corporal punishment
No Emotional Abuse
No name calling
No threatening
No teasing
No put downs
No embarrassing a camper in front of others
No Sexual Abuse
No inappropriate touch
No possession and/or sharing of inappropriate material (including on a phone)
No discussion of inappropriate material or topics
Staff behavior must be appropriate at all times.
Staff must DO what is right
It must LOOK right (maris ayin)
It must FEEL right to the camper(s)
Signature
Date
Behavior Management Policy
1. Discuss camp rules with all campers.
2. Discuss the consequences of breaking any rule.
3. Be consistent in application. Enforce all rules at all times.
4. Apply the consequences of rule breaking in a uniform and consistent manner.
5. Help campers understand and develop positive alternative behaviors which are appropriate to replace the unacceptable ones.
6. Use positive intervention methodologies.
7. Acceptable consequences of rule breaking include:
a. Quiet time b. Restriction from activity c. Cleaning appropriate designated facility or area (specific approved procedures and applications only) d. Conference with the director e. Conference with camper’s authorized person Note: Define acceptable consequences, specify under what conditions and circumstances consequence is permitted, and identify who is allowed to administer specific consequences.
8. Keep the camp director informed of all disciplinary measures. Prepare an unusual incident report.
9. At no time is discipline to include:
a. a. Depriving a camper of sleep or food b. Placing a camper alone without supervision c. Subjecting a camper to ridicule or threat d. Subjecting a camper to excessive physical exercise or excessive restraint* e. Corporal punishment
10.Periodic evaluations of program/staff/camper groupings shall be conducted to insure that the camp environment is not contributing to behavior problems.
11.* If restraint is required to protect a camper from himself / herself or to protect other campers from the camper, only those staff who have received training in the use of restraint may implement the restraint.
12. Follow camp procedures explicitly. Do not freelance. At no time is a staff member to deviate from this policy.
Signature
Date
STAFF RESPONSIBILITY FORM
I will be responsible for my campers.
I understand that I am the adult in the camp setting and act appropriately.
I will not engage in any physical, emotional, or sexual abuse.
I will do what is necessary to prevent abuse in any form.
I will report any abuse or suspected abuse to the head counselors and /or Mrs. Lifshitz within 12 hours. (if reported to the HCs and feel it was not dealt with, make sure to inform Mrs. Lifshitz)
I declare that I have not engaged in, been accused of, or convicted of child abuse.
I will report to the head counselors any situation between campers, like teasing or bullying that I cannot fully resolve within 24 hours.
I will watch for signs of stress in myself and others and ask for support when needed, so that situations do not get out of hand.
I am aware that lack of sufficient sleep can cause stress.
I will avoid being alone with a camper.
I will have private conversations with campers in a place that is in full view of others.
I will not appear completely undressed in front of campers, even for activities such as showers or mikva.
I will not leave a camper unsupervised. ( not due to illness, time-out, etc.)
I am committed to make the environment of camp a chassidishe one, with all that that entails ( be a dugma chaya, treat campers with love and respect, have a chayus, do not undermine authority, etc.)
It is my responsibility to know and follow the rules and schedules of camp.
Signature
Date
Camp Gan Israel – Detroit, Michigan does not have medical insurance and is not liable for any injury incurred by the staff member, whether it was the fault of the staff member, a camper, staff member or any other circumstances in camp. staff member must have full medical insurance and parents must be willing to pay insurance deductibles and co-pays. We will use payment method on file for all cost incurred.
Camp highly recommends that if you don’t have insurance or if your insurance doesn’t cover out of state, you get travel insurance. You can call Mr. Noach Heimen 718-387-2114 or Allianz offers medical coverage for as low as $26. Make sure to put $0 for trip cost when filling out quote. Https://www.allianztravelinsurance.com/
Parent/Guardian Authorization for Health care
This health history is correct and accurately reflects the health status of the staff member to whom it pertains. The person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to the physician selected by the camp to order x-rays, routine tests, and treatment related to the health of the applicant for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this applicant. I understand the information on this form will be shared on a “need to know” basis with the camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of the applicant’s health record from providers who treat the applicant and these providers may talk with the program’s staff about the applicant’s health status.
Please bring your insurance card or a copy of your insurance card.
Parent's signature
All staff under 18 require parents signature