Yeshivas Kayitz

Mesivta Application

Please fill out all required fields marked with *

1
Student Info
2
Parent's Info
3
Medical
4
Payment

Student's Information

Emergency Contact

Parent's Information

General Medical History

Medical Form

Medical Insurance Details

Physical Examination

Health & Medical Concerns

Sunscreen Policy

Medical Documents

Medication Authorization

All medication brought to camp must be self-administered by the camper. A signed doctor's authorization is required on file for any medication your child will take at camp, including over-the-counter medications such as Tylenol and Advil. Our camp health director is a certified EMT and can supervise medication, but cannot administer it directly. Please upload the signed doctor's authorization form below.

Doctor's Authorization for Medication

Physical Examination / Health Clearance Form

Upload a copy of your child's most recent physical examination or health clearance from your physician.

Immunization Records

Upload a copy of your child's current immunization records.

Medical Authorization Signature

By signing below, I authorize the camp staff to provide the medical care described in this form and confirm that the information provided is accurate to the best of my knowledge.

Click here to sign

A popup will open for you to draw your signature
Signature

Payment Information

Summer Program Fee: $2,100.00 USD
Total: $2,100.00 USD

Please make the check out to Mesivta Ohr Temimim.

Total: $2,100.00 USD

American Express is not accepted.

Draw Your Signature

Draw Your Signature — Income Eligibility