Camp LeMaalah Registration Form 2024

You may want to press save on the bottom of the form if you would like to continue later.

You will need to know the last date of each child's tetanus shot; please obtain that information from your pediatrician if you don't have it.

For technical assistance, please email LeMaalahForms@gmail.com

Family Last Name*

Parents' Titles*

Marital Status*

Father's Name*

First NameLast Name

Father's Email*

example@example.com

Father's Cell Phone Number*

Area CodePhone Number

Father's Work Phone Number

Area CodePhone Number

Mother's Name*

First NameLast Name

Mother's Email*

example@example.com

Mother's Cell Phone Number*

Area CodePhone Number

Mother's Work Phone Number

Area CodePhone Number

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number*

Area CodePhone Number

Form Notification Should be Sent to:*

example@example.com

List two people, other than parent/guardian, for us to contact in case of emergency (even if you are always available).

Emergency Contact 1 Name*

First NameLast Name

Emergency Contact 1 Phone Number*

Area CodePhone Number

Emergency Contact 1 Relationship to You*

Emergency Contact 2 Name*

First NameLast Name

Emergency Contact 2 Phone Number*

Area CodePhone Number

Emergency Contact 2 Relationship to You*

Pediatrician Name*

First NameLast Name

Pediatrician Phone*

Area CodePhone Number

Pediatrician Address*

Do all the children you are signing up reside in the USA?*

YesNo

AGREEMENT AND AUTHORIZATION Part 1

A $200 non-refundable, non-transferable & non-postdated activity deposit fee per camper must accompany each registration form. This deposit will be applied toward the camp costs.

Registration forms will only be processed upon the receipt of the deposit fee.

Upon acceptance, the entire camp fee and forms must be submitted by the date on your invoice. 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. Please see payment plan options on the Pay and Submit page.

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 LeMaalah 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 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 LeMaalah permission to use any photographs or media in which my child appears.

Signature of Parent/Guardian*

Camp Lemaalah Registration Form 2024

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.

Please note: If any special medical intervention, ie medicine, is needed during the camp day, a medical plan must be completed.