Camper #1 Information

Please have your child's pediatrician fill out the Ohio Child Medical Statement

Camper #2 Information

Please have your child's pediatrician fill out the Ohio Child Medical Statement

Camper #3 Information

Please have your child's pediatrician fill out theOhio Child Medical Statement

Agreement and Authorization 

A $100 non-refundable, non-transferable & non-postdated activity deposit fee per camper must accompany each registration form. This fee will be applied to the total amount of camp tuition. All families must submit 50% of the entire camp fee by May 19,2023 and 100% of the entire camp fee (and any required forms including an updated medical form) by June 19,2023. Any payment after this date will incur late fees.  No refunds or reductions will be given for days missed (including for illness) or for early departure from camp.

All parents/guardians must accurately complete the medical information for each registered camper before their child(ren) can join camp activities. 

I have read the terms above, and agree to them.  I hereby authorize Camp Mesamchim to administer First Aid or non-prescription pain medication, to be taken by camp personnel or emergency transport to a doctor or hospital for any treatment which Camp Mesamchim deems necessary.  Furthermore, I hereby give my child permission to take part in all camp activities and to participate in all trips off campgrounds.  I give Camp Mesamchim permission to use any photographs or media in which my child appears.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Deposit fee can be paid via Paypal in the section below, via Zelle to campmesamchim@gmail.com or check to 2598 Dover Rd. Invoices for final prices will be sent on a later date.