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Randall's Island Park Alliance
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C.B.O. REGISTRATION FORM
1
C.B.O. Information
2
Camp Session Selection
3
Activity Selection
4
T-Shirt Sizes
5
Insurance
C.B.O. Information
To reserve a place for your organization at Randall’s Island Summer Camp, please fill out and return this form by May 28, 2021.
Organization Name
*
Organization Street Address
*
Organization Street Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Office Telephone
*
Office Telephone Ext.
Office Fax Number
Cell Phone
*
Email
*
Registering Person/Title
*
Please list your mode of transportation to Camp at Randall’s Island (e.g. school bus, van, on foot, or public transportation – must complete this even if buses have not yet been confirmed):
*
Camp Session Selection
Session Dates
Week of 7/5 - 7/8
Week of 7/12 - 7/15
Week of 7/19 - 7/22
Week of 7/26 - 7/29
Week of 8/2 - 8/5
Session Schedule
Session 1 – 10:15AM to 11:00AM
Session 2 – 11:15AM to 12:00PM
Session 3 – 1:15PM to 2:00PM
Session 4 – 2:15PM to 3:00PM
Lunch – 12:00 PM to 1:00 PM (Bring your own lunch and drinks if you will be eating lunch on the island).
Week of 7/5 - 7/8
Monday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Tuesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Wednesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Thursday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Number of Kids:
Ages (6-12 only):
Week of 7/12 - 7/15
Monday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Tuesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Wednesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Thursday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Number of Kids:
Ages (6-12 only):
Week of 7/19 - 7/22
Monday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Tuesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Wednesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Thursday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Number of Kids:
Ages (6-12 only):
Week of 7/26 - 7/29
Monday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Tuesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Wednesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Thursday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Number of Kids:
Ages (6-12 only):
Week of 8/2 - 8/5
Monday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Tuesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Wednesday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Thursday Sessions:
10:15AM to 11:00AM
11:15AM to 12:00PM
1:15PM to 2:00PM
2:15PM to 3:00PM
All Day
Number of Kids:
Ages (6-12 only):
Activity Selection
Campers will be rotated throughout all activities, however, we will try to honor your choices whenever possible.
Basketball
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Tennis
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Volleyball
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Kickball
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Wiffleball
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Soccer
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Disc Activities
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Nature
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Physical Fitness
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Dance
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Track & Field
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Urban Farm
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Nature Arts & Crafts
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
FDNY Tours
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Capoeira
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Biking
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
Self-Defense
Choose One or Leave Blank if Not Interested
First Choice
Second Choice
Third Choice
T-Shirt Sizes
T-Shirt Sizes for Campers
Using the fields below, please indicate how many t-shirts will be needed of each size.
Each child and counselor will be given one t-shirt.
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
T-Shirt Sizes for Staff
Using the fields below, please indicate how many t-shirts will be needed of each size. Note: Staff t-shirts come in adult sizes only.
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Insurance
In order for your C.B.O. to participate in Summer Camp you must provide RIPA with a Certificate of Insurance evidencing your organization has insurance. This Certificate of Insurance must list Randall’s Island Park Alliance, Inc. and the City of New York as Additional Insureds.
Upload your Certificate of Insurance
*
Max. file size: 50 MB.
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