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What is Jewish Camp? Why Jewish Camp? Jewish Camping in the News The Foundation for Jewish
Camp (FJC)

Please note that this application is for first-time campers only, returning campers who are eligible for the second-year $750 grant should please inquire directly with your camp.

Note: Please complete a separate application for each eligible camper child.

Note: All fields marked with asterisk (*) are compulsory.

Name of Person Filling out this Form:*	First Name Last Name
Date of this Grant Application:*	(mm/dd/yyyy)

SECTION #1 – CAMPER SECTION

First Name:*		Last Name:*
Male/Female:*	Male Female	Date of Birth:*	(mm/dd/yyyy)
Current Grade:*		School Name:*

Street:*		City:*
Postal Code:*		Phone:*	(Phone no. should not contain any dashes)
Age:*

SECTION #2 – PARENT/GUARDIAN SECTION

First Name of Parent/Guardian 1:*		Last Name:*
Occupation:*
	Address same as section1
Street:*		City:*
Postal Code:*		Primary Phone Number:*	(Phone no. should not contain any dashes)
Email:*		Secondary Phone Number:*	(Phone no. should not contain any dashes)

First Name of Parent/Guardian 2:		Last Name
Occupation:
	Address same as section1
Street:		City:
Postal Code:		Primary Phone Number:
Email:		Secondary Phone Number:

SECTION #3 – CAMP SECTION

Name of Camp:*		Camp Session:*
Length of Session :*

SECTION #4 – BACKGROUND INFORMATION

PLEASE TELL US ABOUT YOUR CHILD…

What is the main type of Jewish schooling he/she is receiving this year? *

	None
	Sunday school or another one-day-per-week school
	A religious school that meets two days per week
	A religious school that meets three days per week
	Other

Has your child ever been to Israel? *

Yes

PLEASE TELL US ABOUT YOUR FAMILY…

Who in your family has previously attended a non-sectarian overnight summer camp? "Non-sectarian camp" is defined an overnight camp experience without any specifically Jewish content, and where counselors do not adhere to any specific religious affiliation (check all that apply) *

One of the camper's parents/guardians

Both of the camper's parents/guardians

Camper's Sibling(s)

Nobody

Who in your family has previously attended a Jewish overnight summer camp? "Jewish camp" is defined as an overnight camp experience that has significant Jewish content, e.g. programming, services, in addition to regular camp programming, and where the bunk counselors are Jewish.
(check all that apply) *

One of the camper's parents/guardians

Both of the camper's parents/guardians

Camper's Sibling(s)

Nobody

Does your family belong to a synagogue?
Yes
No

Is your family currently a member of a Jewish Community Centre (JCC)?
Yes
No

Are any children in your family members or alumnus of The PJ Library – York Region Program?
No Affiliation
Member
Member And Alumni

PLEASE TELL US ABOUT YOURSELF…

What denomination do you currently consider yourself to be? *

	Orthodox		Traditional		Conservative		Reform
	Reconstructionist		Secular		Other Jewish

Have you or your spouse/partner ever been to Israel? *

Yes

What is the main type of Jewish schooling you received as a child, if any? *

	None
	Sunday school or another one-day-per-week school
	A religious school that meets two days per week
	A religious school that meets three days per week
	Jewish day school
	Other

Birthplace of parent/guardian #1

Birthplace of parent/guardian #2

Do either one or both of the camper's parents/guardians identify as being Jewish?
Yes
No

Are you currently: *

Married

Single/never married

Divorced or separated

Widowed

Living with someone in a committed relationship

How did you find out about the Top Bunk program? *
Referred by:

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SECTION #5 –ACKNOWLEDGEMENT, AGREEMENT, AND RELEASE

In submitting this application, I certify that my child meets all the criteria for eligibility to receive an Incentive Grant for the 2010 summer through the TopBunk program. I also acknowledge that, in the spirit of making Jewish overnight camp an immersive experience, eligible camp sessions must be a minimum of three weeks, and that failure to attend for this minimum amount of time will result in the forfeiting of this grant. Finally, I acknowledge that all information on this Grant Application is accurate and complete, and I understand that incomplete applications will be rejected.

ACKNOWLEDGMENT, AGREEMENT AND RELEASE JEWISH OVERNIGHT CAMPING INCENTIVE GRANT PROGRAM - SUMMER 2012 Congratulations on being considered to receive an incentive grant ("Grant") to help pay the cost of attending a Jewish summer camp. The Grant is provided by UJA Federation of Greater Toronto and the United Jewish Appeal of Greater Toronto, nonprofit corporations ("Federation"), and the Foundation for Jewish Camp (the "Foundation"). The Grant will be made directly to the Jewish summer camp, which you select from a list of participating summer camps ("Summer Camp") to help defray the cost to attend the Summer Camp. The Federation and the Foundation are collectively referred to as the "Funders". The child participating in the Summer Camp for which a Grant is applied for shall be referred to as the "Participant". In consideration of receiving the Grant, the undersigned acknowledges and agrees to the following: 1. By checking the box below (your "Digital Signature"), you hereby acknowledge that: none of the Funders are the operator of the Summer Camp and do not endorse or recommend any Summer Camp. The role of the Funders is limited strictly to providing the Grant directly to the Summer Camp. The Participant shall be solely responsible for the selection of the Summer Camp and assumes all risk associated with attendance at the Summer Camp. 2. Your Digital Signature below hereby further acknowledges that: (i) the Summer Camp may provide activities that could affect the health of the Participant and include risk of injury to the Participant; (ii) the undersigned shall be solely responsible for evaluating and assuming the risk of Participant's participation in such activities; and (iii) the Funders do not carry or maintain any insurance coverage for the benefit of the Participant, and expressly disclaims any responsibility or obligation to do so. The undersigned expressly and freely assumes any and all risks of death, bodily injury, or property damage sustained while participating or otherwise arising in connection with attending summer camp. 3. Your Digital Signature below hereby further acknowledges that: you and your respective heirs, successors and assigns, hereby and forever release and discharge the Funders and their members, directors, trustees, officers, employees, contractors, agents, affiliates, agencies, and successors and assigns (collectively "Releasees"), from, and covenants not to sue, or commence arbitration or other proceedings against, any of the Releasees with respect to, any and all claims, actions, causes of action and demands of every kind and nature in law, equity, or otherwise, known or unknown, for damages, losses, liabilities, costs and expenses, actual or consequential, past, present and future, arising out of or in any way related to Participant's participation in and attendance with the Summer Camp even if such damages, losses, liabilities, costs and expenses arise in part or in whole out of the negligence or carelessness of Releasees. The Funders shall not have responsibility or liability whatsoever for any action or omission of Summer Camp or any of Summer Camp's employees or agents. 4. Your Digital Signature below hereby represents and warrants that: (i) this agreement is executed without reliance upon any statements, promise, inducement or representation by any of the Releasees; and (ii) this agreement is, or may be deemed to have been, entered into in the Province of Ontario. 5. If one or more provisions of this agreement are held to be unenforceable under applicable law, such provision shall be excluded from this agreement and the balance of this agreement shall be interpreted as if such provision were so excluded and shall be enforceable in accordance with its terms. 6. This agreement will be governed by and construed according to the laws of the Province of Ontario. 7. In the event of any matter involving this agreement, the person(s) not prevailing shall pay the legal fees and costs of the person(s) prevailing in any such matter. 8. I/We understand that this agreement may not be modified or changed in any way, except in writing signed by the Funders and me. PARENTAL OR GUARDIAN WAIVER AND PERMISSION AGREEMENT: By checking the box below (your "Digital Signature") you hereby represent that any acknowledgements or agreements in the Acknowledgment, Agreement and Release are made by the Participant's parent(s) or guardian(s) on behalf of the Participant. Your Digital Signature below certifies that you are the parent(s) with legal custody of the participant and/or legal guardian(s) of the person designated as Participant above, the Participant is under the age of eighteen (18) years of age, and that the undersigned is of legal age, legally competent and authorized to execute and deliver this Acknowledgment, Agreement and Release without the necessity of obtaining any other person or entity's consent or approval, including but not limited to another parent. Your Digital Signature below hereby acknowledges that you have read all of the provisions of the Acknowledgment, Agreement and Release, understand and agree to the contents, are freely and voluntarily affixing your Digital Signature below and that the same acknowledgement would bind yourself, the Participant and your and the Participant's respective heirs, successors and assigns.
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