Camper Registration 2020 Please complete the application below. Camp Kesher RegistrationWhat grade is your camper currently in?*3rd (Three Day Program)4th5th6th7th8th9thCamp Kesher is open to all Jewish teens and tweens currently in grades 4 through 9. 3rd graders may register for our three day Taste of Kesher program to get a sample of what Camp Kesher has to offer! Three Day Program for 3rd GradersCamper Name* First Last Hebrew name (optional) Gender* Male Female Birthday* MM slash DD slash YYYY Current school* Do you have another child registered for the full Camp Kesher?* Yes No What is your other child's name?* Email* Cell Phone* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Medical InformationDoes the camper take any medication on a regular basis?* Yes No Please explain*Does the camper have any allergies?* Yes No Please explain*Does the camper have any behavioral/psychological problems we should be aware of?* Yes No Please explain* Camper InformationCamper Name* First Last Hebrew name (optional) Email* Cell Phone*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Gender* Male Female Birthday* MM slash DD slash YYYY What will your child's shirt size be this summer?*Youth medium (size 8)Youth large (size 10/12)Youth XL (14/16)Adult smallAdult mediumAdult largeCurrent school?* Has your child had a Bar/Bat Mitzvah?* Yes No Are you potentially interested in an "Out of the Box" Bnei Mitzvah experience?* Yes! That sounds awesome! No thank you. Has your child participated in other summer camps in the past?* Yes No Which camps?* Parent InformationParent/Guardian 1* First name Last name What is your relationship to the camper?* Father Mother Cell Phone*Email* Occupation Mailing address* Same as above New address Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Marital Status* Married Divorced Single Parent Is there anything else that we should know about your family circumstances?Parent/Guardian 2* First name Last name What is your relationship to the camper?* Father Mother Cell Phone*Email* Occupation Mailing address* Same as above New address Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Marital Status* Married Divorced Family InformationAre there any other children in the family?* Yes No How many other children are in the family?*OneTwoThreeFourSiblings Name (1)* First Last How old are they, and what school are they currently attending?* Siblings Name (2)* First Last How old are they, and what school are they currently attending?* Siblings Name (3)* First Last How old are they, and what school are they currently attending?* Siblings Name (4)* First Last How old are they, and what school are they currently attending?* Emergency ContactPlease list the name and contact information for the person we should contact in case of an emergency if we are unable to reach the parents/guardians. Emergency Contact 1* First Last Phone*Email Emergency Contact 2 First Last PhoneEmail Medical InformationDoes the camper take any medication on a regular basis?* Yes No Please explain.* Does the camper have any allergies?* Yes No Please explain the allergies.*Are there any behavioral of psychological concerns regarding this camper?* Yes No Please elaborate.* ReferencesAcceptance to all NCSY summer programs is contingent upon positive recommendations from 2 teachers, mentors or community leaders. The people you list will receive an email with a link to complete a recommendation form online.Reference 1* First name Last name Email* Reference 2* First name Last name Email* Additional CampersWould you like to register a second child for camp?* Yes! No. Camper 2 InformationCamper's Name* First Last Hebrew name (optional) Email* Phone*Does this camper have a different mailing address?* Yes No Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Gender* Male Female Birthday* MM slash DD slash YYYY What is your shirt size?*Youth medium (size 8)Youth large (size 10/12)Youth XL (size 14/16)Adult smallAdult mediumAdult largeWhat school are currently attending?* What grade are you currently in?*4th5th6th7th8th9thHave you already had a Bar/Bat Mitzvah?* Yes No Are you potentially interested in an "Out of the Box" Bnei Mitzvah experience?* Yes! That sounds awesome! No thank you. Have you ever attended a camp in the past?* Yes No Please list the camp/s that you have attended in the past.*Please upload a picture of the camper.Max. file size: 512 MB. Medical InformationDoes the camper take any medication on a regular basis?* Yes No Please explain.* Does the camper have any allergies?* Yes No Please explain the allergies.*Are there any behavioral of psychological concerns regarding this camper?* Yes No Please elaborate.* ReferencesAcceptance to all NCSY summer programs is contingent upon positive recommendations from 2 teachers, mentors or community leaders. The people you list will receive an email with a link to complete a recommendation form online.Reference 1* First name Last name Email* Reference 2* First name Last name Email* Terms and Conditions - Application Agreement Authorization, Release and WaiverMy child and I are familiar with the NCSY standards of conduct (www.ncsy.org/standards) and my child agrees to scrupulously uphold these standards throughout his/her participation on the program.We understand that this program is conducted in consonance with NCSY's religious and educational standards. As such, my child agrees to adhere to the program and behave in a manner reflecting positively upon NCSY and my family. My child agrees to dress appropriately in compliance with the NCSY dress code, which states: Girls should not wear halter-tops, mesh, sleeveless shirts, short skirts or short shorts. Boys must always wear a shirt and should wear a kippah on Shabbat. My child and I understand that all NCSY program participants must travel and remain with their assigned groups at all times.I am aware that I will be held responsible for any damage to public or private property that NCSY states my child caused as a Summer Program participant and I agree to fully reimburse all parties involved. I acknowledge that my child may never use or be in the possession of alcohol or narcotics during the summer program, and NCSY may request at any time that my child voluntarily undertake a non-physician administered test for drugs and narcotics. Refusal to take such a test voluntarily or a positive result obtained from such a test will serve as grounds for immediate dismissal.I further affirm my understanding that acceptance to all NCSY summer programs is contingent upon positive recommendations from 2 teachers, mentors or community leaders and a completed copy of NCSY's applicable health history form. Additionally, each participant must submit a completed copy of NCSY's applicable medical form and a copy of his or her medical insurance card. All decisions regarding acceptance are at the sole discretion of the Director of NCSY Summer Programs.I am entering this agreement on behalf of both my child and myself, and understand this agreement will be binding on both of us. I have read this release and I fully understand its contents.Parental Authorization: Photo, Audio and Video Media Recordings As a condition of my child's participation on an NCSY Summer Program, I hereby grant permission, without reservation, to NCSY and the OU to take and to use photographs and/or sound/image and/or video recordings (any of the foregoing, Media Recordings ) of my child to describe such Summer Program and to use the same for promotion of good will, public education, and/or fundraising and other related activities of NCSY and the OU, and I waive any right to inspect or approve the photograph(s) or finished version(s) of works incorporating the Media Recordings. This includes posting Media Recordings on public websites and social media outlets.By checking below, I release both NCSY and the OU, its officers, trustees, agents, employees, independent contractors, licensees and assignees (including photographers), from all claims that I may have or might have, for any cause of action arising out of taking/recording and/or use of Media Recordings described in this section.By checking below, I waive any present or future claims I may have based on any usage of Media Recordings described in this section.I have read this release and waiver and I fully understand its contents. In consideration of the acceptance of my child to the NCSY Summer Program for which we have applied, I do hereby agree to the five items listed below:1. Compliance: My child shall comply with all rules, regulations and standards of conduct fixed by NCSY, its agents and employees. I acknowledge and understand that either one of (a) the director of the individual program attended by my child (b) or the NCSY Director of Summer Programs has the right to terminate my child's participation if either deems it necessary for the best interest of the program. In the unlikely event of such termination, I understand NCSY will use its best effort to secure travel arrangements for my child to return home, taking into account all the practical considerations and difficulties (flight availability, cost, etc.) this presents and no refunds will be issued. Such travel arrangements may be unchaperoned if the determination of the Program Director or Director of Summer Programs deems it reasonable to do so. In the event I decide to terminate my child's participation prior to the program's conclusion, I will assume all responsibility to coordinate my child's unchaperoned travel arrangements to return home. In either of these cases, I understand that any and all expenses associated with the termination will be my sole responsibility and no refunds will be issued.2. Cancellation and Withdrawal: Please see our Pricing & Terms page on our website. Additionally, the duration, itinerary or other details of the program may be canceled, curtailed, altered or modified (any of the foregoing, a Program Modification ), at the sole discretion of NCSY, for any reason, without prior notice, obligation, or reimbursement.3. Medical: I hereby affirm that my child has been or will be examined by a qualified licensed physician in compliance with this NCSY Summer Programs registration process. Said physician is in possession of all pertinent facts concerning my child and the program for which he or she is applying. As will be confirmed by the Physician's Statement that will be sent to NCSY subsequently, my child is in good health, may travel as required, and is free from any physical, psychological, or emotional disability or weakness which might endanger or negatively impact upon my child's experience or the experience of those with whom he or she travels. Should it appear to the director of my child's summer program (the Program Director ) that my child is suffering from any condition - physical, psychological, or emotional- that could negatively impact upon my child's experience or the experience of those with whom he or she travels, then, my child may, at the sole and absolute discretion of NCSY or its representatives, be returned home at my sole expense, and there shall be no refund of money paid for the program. I further understand that, in the event of an illness or injury requiring treatment for my child, the Program Director will make reasonable attempts to contact me before treatment is administered where practically possible, unless the illness/injury is of such minor extent that only minimum first aid treatment or non-prescription medication (e.g. Tylenol, Advil, Kaopectate, Antihistamine, etc.) is required. Though NCSY is not required to provide such treatment, I hereby authorize the Program Director to make such decisions. In this spirit, I will complete all medical-related forms and advise NCSY of any medications (over the counter or otherwise) which may not be administered to my child. In the event I cannot be reached in a reasonable amount of time using reasonable diligence, I authorize the Program Director to obtain from the local medical clinic or district hospital, or to provide on-site, the necessary medical attention for the complete health of my child and such treatment as described above. In the event I cannot be reached in a reasonable amount of time using reasonable diligence, I also give permission to the physician or EMT selected by NCSY to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child. I agree to reimburse immediately and/or accept financial responsibility for the total cost of all medical care provided to my child. By checking below, I release said medical personnel, NCSY and the OU, their officers, trustees, agents, employees, independent contractors, licensees and assignees from any liability or responsibility for any judgments or decisions made in the obtaining and rendering of medical assistance and treatment for my child. As a condition of my child's acceptance, I agree to submit without delay a form filled out by my child's physician attesting to his/her suitability for this program. Note to parent: The form will be e-mailed to your child upon completion of on-line registration.4. Mailing List Permission: As a condition of my child's participation in the Summer Program experience, I agree to permit my child's name and contact information to be shared with NCSY professionals and other program participants.5. Travel Awareness: NCSY provides travel arrangements for all Summer Program participants and bus transportation will be available from the NCSY office. My child and I further understand that NCSY and the OU shall, in no way, be deemed responsible for the operation or management of any means of transportation, public or private, or facilities used or enjoyed by the program.By clicking "yes", I accept the terms and conditions stated above and acknowledge that I will be charged if NCSY needs to bill me for any vandalism charges or for any expenses incurred to send my child home upon early termination of the summer program.* Yes No Are you sure? By choosing not to agree to the terms and conditions, your application will be invalid and your child will not be accepted into camp.* Yes. I am sure. No, that was a mistake. I will change my selection above to "yes". PaymentIf a camper does not get accepted, the payment will be refunded. For more information, you can see the financials page on the website.Application fee* One camper Two campers Payment options* Full price I'd like to apply for a scholarship Taste of Kesher program for 3rd graders costs $250 (including the $50 registration fee). Payment options* Full price I'd like to apply for a scholarship Taste of Kesher program for 3rd graders costs $250 (including the $50 registration fee). Total $0.00 PaymentA $50 registration fee (per application) is due at the time of application. If a camper does not get accepted, the registration fee will be refunded. For more information, you can see the financials page on the website.Application fee* One camper Two campers Please select your payment option.* All $1449 now. Half now, half later. I'd like to apply for a scholarship. Please select your payment option.* All $2898 now. Half now, half later. I'd like to apply for a scholarship. Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name
