BEFORE SUBMITTING, PLEASE READ: *If you are a new applicant, you will be asked to attend an interview with the director before / after Pesach time. **If you are between the age of 16-24, and you have applied for SYEP, please send us confirmation of enrollment. - The provider should be HANAC, Inc. (YOU WILL BE ASKED TO PUT IN YOUR SYEP ID# BELOW) ***Once accepted to work in camp, you will be required to submit a current medical record, dated within the past two years (age 16+), as well as a resume listing your past experiences & references. Full Name* First Name Last Name Age* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Current Grade* 6789101112SeminaryYeshivaCollegeFinished SchoolOther E-mail* Cell Number* Area Code Phone Number Is this your number? YesNo Home Number Area Code Phone Number Address* Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country School Attending* School Phone Number Area Code Phone Number Parent Info Mother's Name Mother's Phone Number Area Code Phone Number Mother's E-mail Emergency Contact Emergency Contact* First Name Last Name Phone Number* Area Code Phone Number Relationship Work / Camp References Reference #1* First Name Last Name Phone Number* Area Code Phone Number Relationship* Reference #2* First Name Last Name Phone Number* Area Code Phone Number Relationship* More information: Have you been a counselor at CGI Queens before?* YesNo If yes, what years? (Click all that apply) 20252024202320222021 or previous Dates Applying For ?* Full Summer (June 25-August 13)First Session (June 25-July 17)Second Session (July 20-August 13) Will you be 16 by July 1st, 2026 and applied to SYEP (youthcore)?* YesNo If yes, what is your SYEP #? If not, please expain why? Age Bunk Preference (please check off more than one)* Kiddie Division1st grade Division2nd - 4th Grade5th - 7th gradeNo Preference What is your T-shirt Size?* Adult SAdult MAdult LAdult XLAdult XXL Would you need bus transportation every day?* YesNo Bus address (if different than home address): If needed, would you be interested in being a bus monitor?* YesNo Do you have a current CPR / RTE card?* YesNo If yes, expiration date Feel free to let us know if you have any questions or comments. For more info, or questions, please email [email protected], OR message the camp director, Mrs. Chanie Zalmanov at 917-613-0223. 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