Registration 2024 First Name(Required) Last Name(Required) Date Of Birth(Required) MM slash DD slash YYYY Current Grade(Required)9th Grade10th Grade11th Grade12th GradeYeshiva(Required)Please selectNer YisroelKaminetzFather First Name(Required) Mother First Name(Required) Father Occupation(Required) Mother Occupation(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Home Phone(Required)Parents Marital Status(Required)MarriedDivorcedWidowedFather Cell(Required)Mother Cell(Required)Father Email(Required) Mother Email(Required) Emergency ContactEmergency Contact Name(Required) Emergency Contact Relation(Required) Emergency Contact Phone Number(Required)Payment InformationTo keep things as efficient as possible - the camp fee of $2,500 can be paid for via Credit Card or ACH. The complete camp fee of $2,500 must be paid in full prior to June 15th.Please select a payment schedule(Required) Pay in Full 4 Monthly Payments Please select a payment method(Required) Credit Card ACH Please be aware that a 3% surcharge will incur for CC usage.For any questions or concerns - please reach out to us at tammuz@campteumim.comNer Yisroel has a limited amount of scholarship funds available on a need based basis. Please be aware that parents are completely responsible for the full camp fee of $2,500 and must fill in the payment section fully in order to request a scholarship. In order for a scholarship request to be considered - this form must be submitted no later than March 31st. If you receive a scholarship - you will be notified and your payment(s) will be adjusted accordingly. Scholaship Request To apply please click here Please explain the reason for your scholarship request Recurring ACH Total Price: $470.00 Recurring CC Total Price: $470.00 One Time CC Total Price: $470.00 One Time ACH Total Price: $470.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name ACH Account Number SelectSavingsChecking Account Type Routing Number Account Holder Name 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 tammuz@campteumim.com or mailed to Teumim Mesivta/Tammuz Program - 3 Elderberry Ct. Lakewood NJ 08701. Click Here To DownloadFOOD FORM EVERYONE MUST FILL OUT A FOOD FORM.Please download & complete the Food form. ALL BOYS THAT ARE ELIGABLE WILL RECEIVE $100 OFF THE CAMP PRICE. Completed forms can be uploaded and emailed to tammuz@campteumim.com or mailed to Teumim Mesivta/Tammuz Program - 3 Elderberry Ct. Lakewood NJ 08701. Click Here To DownloadConsentI hereby authorize Camp Teumim Mesivta, Ner Israel Rabbinical College & Yeshiva Toras Emes Kamenitz (hereinafter 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 Signature Please type Full Name hereDates July 2 - July 28 E-mail tammuz@campteumim.com Winter Address 3 Elderberry Ct. Lakewood NJ 08701 Summer Address 574 Proctor Rd. Glen Spey, NY 12737 Kamenitz Rabbi Y.M. Zelinger 347.930.9749 mesivta@ytek.org Ner Yisroel Rabbi Y. Neuberger 443.413.7721 yneuberger@nirc.edu
