Registration | Camp Teumim Mesivta

Family

Your family information

Family last name*

Marital status*

Shul/Community*

Please indicate Rav/Shul/Community which your family is part of

Address

Your home address

Address*

City*

State*

Zip*

Father's Information

Contact details for father/guardian

Title*

First Name(F)*

Cell #(F)*

Email(F)*

Occupation(F)*

Mother's Information

Contact details for mother/guardian

Title*

First Name(M)*

Maiden name*

Cell #(M)*

Email(M)*

Occupation(M)*

Emergency Contact 1

Someone we can reach in case of emergency

Emergency contact name*

Emergency contact Phone*

Emergency contact Relationship*

Payment Information

Review your charges and make a payment

Camp fee is $3,495.

An $895 deposit will be charged 48 hours after an acceptance email is sent to you.

If you do not want the slot - we must hear from you within these 48 hours or the deposit charge will be processed and not returned.

For the remaining balance - 4 charges of $650 each will be charged monthly - one month after the deposit charge is processed.

A monthly payment plan of $650/month is ONLY applicable for those who have been accepted by April 2027.

After April - the camp fee of $3,495 will be divided evenly from the time of acceptance until the first day of camp(8/8/2027)

On the first day of camp(8/8/2027) - any outstanding balance remaining will be charged in full

*Please be aware that 3% is added to every CC transaction and 1% is added to every ACH transaction*

Total

$0.00

Payment method*

A minimum deposit of $895.00 will be due

Complete camper details above to calculate the exact amount.

Disclosures & Consent

Please review and agree to the following

I agree to pay the full tuition amount by the start of the camp season - (8/8/2027). I understand that failure to pay may result in my son being unable to attend.

I grant permission for my son to be photographed or videotaped during camp activities. These images may be used for camp promotional materials, social media, and the camp website.

I authorize the Medical Director and all of his staff to make medical decisions and seek medical treatment for my child. I understand that I will be responsible for any medical expenses incurred.

In consideration of my son being allowed to participate in this sport camp program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: 1) The risk of serious injury from the sports activities involved in this program is always present due to the nature of the sport(s). 2) For myself, spouse, and child, I knowingly and freely assume all such risks, both known and unknown – even if arising from the negligence of the releases or others, and assume full responsibility for my child’s participation. 3) I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation. If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from participation and bring such to the attention of the nearest official immediately 4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the Camp Teumim LLC, a limited liability company formed under the laws of the State of New Jersey, its affiliates, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises use for activity (“Releases”), with respect to any and all injury, disability, death, or loss or damage to person or property, regarding my child and/or arising from his activities, whether arising from negligence of the releases or otherwise, except for willful misconduct, or otherwise to the fullest extent of the law. I have read this liability form agreement, fully understand their terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. The health history submitted to Camp Teumim Mesivta is correct and complete as far as I know. My son, NAME has permission to engage in all camp activities except as noted. It is my intention that the camp be treated as acting in loco parentis if the person herein named is a minor. Further, it is my intention that the appropriate representatives of the camp be treated as “personal representatives” for the purposes of disclosing protected health information pursuant to the privacy regulations promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996. I hereby agree (pursuant to 45 CFR § 164.510(b)) to the disclosure to camp representatives of the protected health information of the person herein described, as necessary: (i) to provide relevant information to the camp representatives related to the person’s ability to participate in camp activities; and (ii) in the case of minors, to provide relevant information to the camp representatives to keep me informed of my child’s health status. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp. I understand that part of the Camp experience involves activities and group living arrangements and interactions that may be new to my child, and that they come with certain risks and uncertainties beyond what my child may be used to dealing with at home. I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by the Camp’s rules, and my child and I both agree that he or she is familiar with these rules and will obey them. I hereby give permission to the camp to provide, seek, and consent to routine health care, administration of prescribed medications, and emergency treatment for me/my child, as may be necessary, including, but not limited to x-rays, routine tests and treatment, and/or hospitalization. I also give permission for the camp to arrange related transportation. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. New York State requires permission from a parent for their child to carry insect/tick repellant on them - please email your consent if your son will be carrying this on him.

I agree to receive text messages from Camp Teumim Mesivta about important updates, reminders, schedule changes, billing/account notices, and occasional announcements or marketing promotions. Mobile opt-in data will not be shared with third parties for promotional and marketing purposes. Message frequency may vary. Msg & Data rates may apply. Reply STOP to unsubscribe. Text HELP for help. Consent is not a condition of enrollment. View our Privacy Policy and Terms & Conditions.

I am the parent/guardian and consent to providing my children's information. I agree to the Terms of Service and Privacy Policy.

We collect camper health, contact, and program data. You may request access or deletion via the camp office.

Signature

Sign below to confirm

Parent signature

Print name*

Date of signature

Camp Teumim Mesivta

Registration is now open for the Summer 2027 season!

Looking forward!