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Camp Office Email

This is the email address for the camp's office

Registration 2025 - Belle Harbor

First Name*

Last Name*

Date Of Birth*

Current Grade*

Yeshiva*

Father First Name*

Mother First Name*

Father Occupation*

Mother Occupation*

Address*

Street Address City State ZIP Code

Home Phone*

Parents Marital Status*

Father Cell*

Mother Cell*

Father Email*

Mother Email*

Emergency Contact

Emergency Contact Name*

Emergency Contact Relation*

Emergency Contact Phone Number*

Insurance Information

Insurance Provider for your son*

Insurance Policy # for your son*

Please list any allergies/restrictions your son has if applicable

Payment Information

Price: $2700 Please provide CC info here which we will bill evenly monthly. Application will not go through without a valid CC. If you would like to pay an alternate way - after entering CC info - please reach out to camp@ymhbh.com to discuss.

Payment Options:*

Pay in Full

Pay Over 4 Months

To secure your slot, we require a down payment of $700. After that, you can choose the 4-month payment plan, which would involve paying an additional $500 per month until July.

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Total Amount

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Deposit

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Card Multiplier

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Recurring Start

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Recurring Times

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Recurring Amount

Total:

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Due Now:

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Recurring Amount:

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Remaining Balance:

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Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Please be aware that a 3% surcharge will incur for CC usage.

Medical Forms

Please download & complete the entire file of medical information that is required by NY State in order for your son to be on the Teumim Mesivta campgrounds for this season. A complete set of forms is necessary - partial completion isn't sufficient. Completed forms can be uploaded and emailed to camp@ymhbh.com or mailed to Yeshiva Mercaz Hatorah of Belle Harbor PO Box 940297 Belle Harbor NY 11694

Click Here To Download

Food Form

All campers are required to complete the lunch form regardless of income. ALL BOYS THAT ARE ELIGABLE WILL RECEIVE $100 OFF THE CAMP PRICE.

Please download the info Click Here>> and complete the form.

Completed forms can be uploaded and emailed to camp@ymhbh.com or mailed to Yeshiva Mercaz Hatorah of Belle Harbor PO Box 940297 Belle Harbor NY 11694

Consent to participate in off-grounds activities*

I hereby authorize Yeshiva Mercaz Hatorah / Belle Harbor, (herein after camp) to take my son(s) off camp grounds to go on trips organized as part of the camping program. This may include swimming and/or boating sites. In addition, my son(s) may participate in any on or off ground activity organized by camp, including but not limited to land sports, aquatics activities, indoor activities, bicycling, hiking, cookouts, etc., and I assume the inherent risk of such activities and camp programs. I will hold camp harmless in the event of injury or property damage or loss as a result of such activities. I also agree to abide by all rules and regulations as set forth by the camp administration.

I Agree

Consent for Medical Treatment*

I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for my son.

I Agree

Consent for Medical Treatment (2)*

I hereby give permission for Yeshiva Mercaz Hatorah / Belle Harbor to provide, seek, and consent to routine healthcare, administration of prescribed medications, and emergency treatment for my child as may be necessary - including - but not limited to x-rays, routine tests and treatment and/or hospitalization. I also give permission for the camp to arrange related transportation. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes.

I Agree

Signature*

Please type Full Name here

Dates June 30 - July 22
E-mail camp@ymhbh.com
Summer Address 574 Proctor Rd. Glen Spey, NY 12737

For office use