This form will not save your progress. Make sure to have all the documents ready to upload before beginning this part of the application.

Last Name

First Name

Date of Birth

Parent Email

Address

Please attach an updated picture

Please download and complete the attached form. You can edit the file in your browser or as a PDF. Press Tab to get to move to the next field. Please note: School name is Camp Ruach Chaim. When complete, please save the file as your child’s LastName_FirstName and upload below.

A completed Lunch Form is required for every camper. Please fill out your income information, even if you are not eligible.

Download

Upload the file here.

Please make copies of your medical insurance cards and upload to the appropriate box. if you have separate prescription drug coverage, please make a copy of that card and upload it to the correct box below.

Note: A copy of your insurance card is necessary even if you don’t have coverage in New York State.

Name of Insurance

Insurance ID Number

Name on Card

Attach front copy of your medical insurance card

Attach back copy of your medical insurance card

Attach front copy of your prescription drug card (if different than insurance)

Attach back copy of your prescription drug card (if different than insurance)

This medical information form is to be completed by a parent. It is not necessary to have a Physician sign this form. All of the information on this form is kept strictly confidential. We respectfully request that no information be withheld from the camp. You are more than welcome to put a note asking that the appropriate people reach out to you to discuss sensitive information.

An updated immunization record from your child's physician is required. Please upload your daughter's immunization records on the Paperwork Application.

Note: As per the NY Department of Health, two doses of the MMR vaccine and 1 dose of the Meningitis shot must be included in the immunization schedule.

Immunization Form

Date of MMR Dose 1

Date of MMR Dose 2

Do not think that by submitting this application you have applied!

Your application will not be considered complete unless you have submitted Part 1 of your application. If you did not yet submit Part 1 of the application, make sure to go back to the home page and select BRC Staff Application, or copy this link:

https://portal.admirepro.com/brc/apply?WffrmId=488

You will recieve a confirmation email upon submitting each application. If you received each email, you can assume your application has been sent and will be processed.