Clone of Camp Ohr CAMPER Registration Form 2026

Camp Ohr Application
Family Information
Family Last Name*
Home Phone*
Please enter a valid phone number.
Name of Shul and Family Rav*
Father's Information*

PrefixFather's First NameLast Name
Father's Occupation*
Father's Cell*
Please enter a valid phone number.
Father's Email*
example@example.com
Mother's Information*

PrefixMother's NameLast Name
Mother's Occupation*
Mother's Cell*
Please enter a valid phone number.
Mother's Email*
example@example.com
Marital Status*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Stamper Information
Stamper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Entering*
Name of School*
Parent's Email Address*
example@example.com
Stamper's Email Address*
example@example.com
Stamper's Phone Number*
Please enter a valid phone number.
Do you have a lifeguarding certificate?*
Please upload a current photo of a Stamper*

Cancelof
T-shirt Size*

Adult XSAdult SAdult MAdult LAdult XLAdult 2XL
Please list 2 references who know you personally. References should please be a current Teacher/Principal and a Teacher/Principal from last year.
Reference Person's Name (#1)*
Reference's Relationship (#1)*
Reference's Phone Number (#1)*
undefined
Reference Person's Name (#2)*
Reference's Relationship (#2)*
Reference's Phone Number (#2)*
Please enter a valid phone number.
Where did you spend your summer?*
2024
2025
Medical Information
Doctor's Name*
Doctor's Phone Number*
Please enter a valid phone number.
Does your child have any allergies, take medication or have any other medical issue or special requirements? If yes, please explain any instructions.*
Please list any information about your child. This information remains confidential, but helps us better understand your child and help her in case of emergency.*
Do you authorize Camp Ohr to dispense Tylenol/Motrin/Benadryl?*

YesNo
Please Upload An Immunization Form*

Cancelof
Please Upload the Front of your child's Insurance Card*

Cancelof
Please Upload the Back of your child's Insurance Card*

Cancelof
I understand that nit check is a requirement prior to entering camp. it must be done within 48 hours of her arrival and by a seasoned lice checker. Your daughter must come to camp with a certified letter confirming that she is clean. Anyone who does not have that letter available upon arrival (even if she was checked) will be checked and your account will be charged. In the event they find lice or nits in your daughter's hair, initial cleaning will cost a minimum of $300 and then $100 to check her the following week. I have read and acknowledged the above.*

I agree
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Camp Ohr during the selected camping session. In exchange for the acceptance of said child’s candidacy by Camp Ohr, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Camp Ohr and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Camp Ohr including all staff members and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Camp Ohr and its affiliates including Directors, Counselors and Staff members to provide the needed emergency treatment prior to the child’s admission to the medical facility.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Payment Information

Please note:

Camp Dates: Wednesday, July 29 - Tuesday, August 18

Fees: $3,900

Price includes all camp activities.

(IMPORTANT: Price does NOT include airfare, transportation, and luggage.)

Payment Schedule: Deposit of $1,200 is due upon acceptance and will be charged to the card on file 48 hours after your acceptance email has been sent. You have 24 hours to decline the acceptance if you don't want to be charged the non-refundable deposit and instead choose to forfeit your spot.

The remaining balance will be charged in three equal payments of $900 on January 31st, February 28th and March 31st. Please note there will be a 3% processing fee for all credit card payments. There will be no fee for Zelle payments. Please be in touch with us directly if you would like to pay via zelle.

Please note that all balances must be paid up prior to the first day of camp.

Refund Policy: Any cancellation prior to January 15th will incur a service fee of $200. No refunds will be made after January 15th, and cancellation after this date will result in forfeiture of all funds paid. To receive a refund, all cancellations must be submitted in writing.

General Info: Any camper who on the recommendation of Camp Ohr is asked to leave camp during the session, regardless of the reason will be responsible for the full fee, no monies refunded. Late arrivals, early arrivals or absence will not result in any credit or refund. Camp Ohr will not be held responsible for any articles of clothing lost or damaged by fire, theft or the camp’s laundry services. Any and all claims made against Camp Ohr and/or its employees including any monetary disagreements, shall be decided upon only by a Bais Din in accordance with Halacha.

Camp Deposit Info*

Camp DepositDeposit of $1,200 is due upon acceptance and will be charged to the card on file 48 hours after your acceptance email has been sent. You have 24 hours to decline the acceptance if you don't want to be charged the non-refundable deposit and instead choose to forfeit your spot.

$1,200.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Relationship to Stamper*
Date*

MonthDayYear
Date
Signature*

Powered by Jotform SignClear
Should be Empty:

Camp Ohr Application

Please list 2 references who know you personally. References should please be a current Teacher/Principal and a Teacher/Principal from last year.

Medical Information