Camp Mechaya Application

Camp Mechaya Application
Family Last Name*
Home Phone*
Please enter a valid phone number.
Father's Name*
Father's Occupation*
Father's Cell*
Please enter a valid phone number.
Father's Email*
example@example.com
Mother's Name*
Mother's Occupation*
Mother's Cell*
Please enter a valid phone number.
Mother's Email
example@example.com

Address*

Address

Address Line 2

CityState

Zip Code
Emergency Contact #1 Name*
Emergency Contact #1 Relationship*
Emergency Contact #1 Phone Number*
Please enter a valid phone number.
Emergency Contact #2 Name
Emergency Contact #2 Relationship
Emergency Contact #2 Phone Number
Please enter a valid phone number.

Campers*

Please download the below Food Program form and upload it below after filling out all the info.
The Food Program Form is required to be completed. Families eligible for the Food Program will receive a $100 refund from camp.
Completed Food Program Form*

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Front and Back of Insurance Cards*

Please Upload All Campers' Insurance Cards
Cancelof
Immunization Forms*

Please Upload All Campers' Immunization Forms
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Parental Permit

The following consent form must be signed by a parent or guardian of minors so that appropriate assessment and treatment may be promptly carried out, and so that no unnecessary delay will occur with operative procedures. No major operations will be performed except in an emergency, without parents being contacted and fully informed.

I give permission for such assessment, therapeutic and operative procedures as deemed necessary for my son.

Please note that there will be a nurse or EMT on campgrounds during the summer. In the event that your son needs additional care (i.e. trip to an urgent care, orthopedist etc) there will be an additional charge of $50 per trip.

Additionally, any medication that your son is prescribed during camp that will incur a cost greater than $5, we will request that you cover that fee. The same method of payment that you use for registration will be used if ch’v there is a need.
Signature*

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Date*

MonthDayYear
Date
Relationship to Camper(s)*

By clicking on "Continue" you will be redirected to the Cardknox Payment Platform where you can submit your payment for this application.

If you are having any difficulties with the payment page or for any questions, please reach out to us at campmechaya@gmail.com or Call/Text 786-MECHAYA (632-4292) and we'll do our best to help you.

Thank you and have nice day!
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