Yeshivas Kayitz

Zal 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.

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Signature

Payment Information

Summer Program Fee: $2,100.00 USD
Total: $2,100.00 USD
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Draw Your Signature

Draw Your Signature — Income Eligibility