ECC Camp Shemesh Registration 2026 - Form - Midbar Kodesh Temple

Home

Home

ECC Camp Shemesh Registration 2026

We are pleased to announce that registration for Camp 2026 is now open!

Camp will run for 8 weeks this summer!
8:45 AM - 3:45 PM

The fun will begin on Monday, June 1, 2026. Our last day will be Friday, July 24, 2026.

Campers will let their imaginations run wild. We are planning a different adventure each week filled with arts & crafts, water play, sensory experiences, science explorations, surprise guests, dress-up days, music & movement, and so much more!

To register, please complete a registration form for each child.
A non-refundable $100 fee is due for each child attending camp by April 1.
After that date, the price will increase to $150.

Camp balances must be paid in full by June 20, 2026.

Camp Tuition Fees Summer 2026

5 Full Days: $300 per week

4 Full Days: $260 per week

3 Full Days: $225 per week

Before Care
7:30-8:30 AM $10/day

After Care
4:00-5:00 PM $20/day

If you have any issues filling out this form or have any questions, you can reach out to us by email at sandi@midbarkodesh.org or call us at (702) 454-4848.

Enrollment

* Child's First Name

* Child's Last Name

* Child's Date of Birth

Parent: First Name

*

Parent: Last Name

*

Parent: Email Address

*

Parent: Cell Number

* Emergency Contact: First & Last Name

*

* Emergency Contact: Cell Number

*

* Relationship to the Child

*

Choose Your Schedule

Week 1: June 1 - June 5

Week 1: June 1 - June 5

Please choose how many days your child will attend camp:

Week 2: June 8 - June 12

Week 2: June 8 - June 12

Please choose how many days your child will attend camp:

Week 3: June 15 - June 18

Week 3: June 15 - June 18

Please choose how many days your child will attend camp:

Please choose which days:

MondayTuesdayWednesdayThursday

Week 4: June 22 - June 26

Week 4: June 22 - June 26

Please choose how many days your child will attend camp:

Week 5: June 29 - July 3

Week 5: June 29 - July 3

Please choose how many days your child will attend camp:

Week 6: July 6 - July 10

Week 6: July 6 - July 10

Please choose how many days your child will attend camp:

Week 7: July 13 - July 17

Week 7: July 13 - July 17

Please choose how many days your child will attend camp:

Week 8: July 20 - July 24

Week 8: July 20 - July 24

Please choose how many days your child will attend camp:

Waivers

Release and Indemnification Agreement

I, on my own behalf and on behalf of my child, understand that Midbar Kodesh Temple ("MKT") is operating their MKT Early Childhood Center preschool ("preschool"). As consideration for my child’s attendance at preschool, I understand and voluntarily agree to the following: I understand that there are risks associated with participation in the preschool, including but not limited to the potential for my child to contract the COVID-19 virus. I also understand that part of the preschool experience involves activities that may hold certain risks, including those that could result in injury or illness. My child and I willingly assume these risks. I agree to indemnify MKT, including its officers and employees, against all injuries, liabilities, or damages arising from my child’s participation in preschool. I release, waive, and covenant not to sue MKT, including its officers and employees, arising from my child’s participation in preschool. I release said entities from all legal fees/costs, loss, liability, or damage on account of injury or illness caused or alleged to be caused in whole or in part by the negligent acts or omissions of MKT, including its officers or employees.

I, on my own behalf and on behalf of my child, understand that Midbar Kodesh Temple ("MKT") is operating their MKT Early Childhood Center preschool ("preschool"). As consideration for my child’s attendance at preschool, I understand and voluntarily agree to the following: I understand that there are risks associated with participation in the preschool, including but not limited to the potential for my child to contract the COVID-19 virus. I also understand that part of the preschool experience involves activities that may hold certain risks, including those that could result in injury or illness. My child and I willingly assume these risks. I agree to indemnify MKT, including its officers and employees, against all injuries, liabilities, or damages arising from my child’s participation in preschool. I release, waive, and covenant not to sue MKT, including its officers and employees, arising from my child’s participation in preschool. I release said entities from all legal fees/costs, loss, liability, or damage on account of injury or illness caused or alleged to be caused in whole or in part by the negligent acts or omissions of MKT, including its officers or employees.

Medical

I do hereby authorize administrators and members of the staff of Midbar Kodesh Temple (MKT) or Midbar Kodesh Temple Early Childhood Center (MKTECC) or Summer Camp at MKT or their nominees to provide immediate medical care, including the administration of manual AED-assisted CPR, Heimlich maneuver, oxygen or other lifesaving or first aid procedures in the event of a medical emergency. In such cases, I authorize MKT, MKTECC, or Summer Camp at MKT, its administrators, and its staff to activate the 9-1-1 emergency response system. I further consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which may be deemed advisable by, and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any accredited hospital. In the event of a medical emergency, and if MKT or MKTECC or Summer Camp at MKT personnel or their nominees are unable to reach the parent(s) or guardian, I give consent in loco parentis to any doctor or medical facility to administer life-saving medical or surgical treatment and care for my child. I understand and agree that I am responsible for all costs associated with providing emergency medical care to my child. As such, I agree to reimburse MKT or MKTECC or Summer Camp at MKT within 15 days for any costs MKT or MKTECC or Summer Camp at MKT may incur on my behalf as a result of providing emergency medical care to my child. I understand that part of the school and camp experience involves activities and interactions that may be new to my child, and that they hold certain risks. I am aware of these risks, and I am assuming them on behalf of my child. I have instructed my child on the importance of abiding by the school’s and camp’s rules, as well as following directions given to him/her to ensure their safety and well-being. If I choose not to have my child participate in a school or camp activity, I will inform the MKTECC Director or Summer Camp at MKT Director in writing. I understand that at times MKT or MKTECC or Summer Camp at MKT is asked to release information regarding my child/children to school/camp personnel, representatives of welfare, licensing and regulatory agencies, law enforcement, healthcare professionals, and any other person(s) who are deemed as serving in an official capacity as it pertains to the health, safety, and welfare of my child/children. If an inquiry regarding my child/children is from an entity other than a school/camp, or licensing agency personnel, I will be informed of the information requested.

I do hereby authorize administrators and members of the staff of Midbar Kodesh Temple (MKT) or Midbar Kodesh Temple Early Childhood Center (MKTECC) or Summer Camp at MKT or their nominees to provide immediate medical care, including the administration of manual AED-assisted CPR, Heimlich maneuver, oxygen or other lifesaving or first aid procedures in the event of a medical emergency. In such cases, I authorize MKT, MKTECC, or Summer Camp at MKT, its administrators, and its staff to activate the 9-1-1 emergency response system. I further consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which may be deemed advisable by, and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any accredited hospital. In the event of a medical emergency, and if MKT or MKTECC or Summer Camp at MKT personnel or their nominees are unable to reach the parent(s) or guardian, I give consent in loco parentis to any doctor or medical facility to administer life-saving medical or surgical treatment and care for my child. I understand and agree that I am responsible for all costs associated with providing emergency medical care to my child. As such, I agree to reimburse MKT or MKTECC or Summer Camp at MKT within 15 days for any costs MKT or MKTECC or Summer Camp at MKT may incur on my behalf as a result of providing emergency medical care to my child. I understand that part of the school and camp experience involves activities and interactions that may be new to my child, and that they hold certain risks. I am aware of these risks, and I am assuming them on behalf of my child. I have instructed my child on the importance of abiding by the school’s and camp’s rules, as well as following directions given to him/her to ensure their safety and well-being. If I choose not to have my child participate in a school or camp activity, I will inform the MKTECC Director or Summer Camp at MKT Director in writing. I understand that at times MKT or MKTECC or Summer Camp at MKT is asked to release information regarding my child/children to school/camp personnel, representatives of welfare, licensing and regulatory agencies, law enforcement, healthcare professionals, and any other person(s) who are deemed as serving in an official capacity as it pertains to the health, safety, and welfare of my child/children. If an inquiry regarding my child/children is from an entity other than a school/camp, or licensing agency personnel, I will be informed of the information requested.

Sunscreen

I give permission for the staff at MKT ECC or Summer Camp at MKT or their nominees to apply a sunscreen product (brought from home) that is broad-spectrum with SPF 30 or higher to my child when playing outside. I understand that sunscreen may be applied to exposed skin, including but not limited to the face (except eyelids), tops of ears, nose, bare shoulders, arms, and legs. If I choose not to allow a staff member to apply sunscreen, I will inform the MKT ECC Director orthe Summer Camp at MKT Director in writing.

I give permission for the staff at MKT ECC or Summer Camp at MKT or their nominees to apply a sunscreen product (brought from home) that is broad-spectrum with SPF 30 or higher to my child when playing outside. I understand that sunscreen may be applied to exposed skin, including but not limited to the face (except eyelids), tops of ears, nose, bare shoulders, arms, and legs. If I choose not to allow a staff member to apply sunscreen, I will inform the MKT ECC Director orthe Summer Camp at MKT Director in writing.

Public Photo Release

I agree to allow MKT and/or MKTECC and/or Summer Camp at MKT and/or their nominees, the right to record my child’s/ children’s image and/or voice, and consent to allow the camp the perpetual right to use or reproduce this material in all media known or hereinafter devised without compensation.

Please Select OneYESNO

Allergy Questionnaire

Physician's Name

Phone

Clinic Name

Has your child been diagnosed with an allergy by a healthcare provider?

YESNO

Indicate what your child has an allergy to:

Does your child require an Epi Pen?

YESNOIf yes, please bring a non-expired Epi Pen labeled and in its box on your child’s first day of camp.

How old was your child when the allergy was first discovered?

How frequently has your child had an allergic reaction?

What are the signs and symptoms that your child experiences when having an allergic reaction?

How quickly do symptoms typically occur after exposure to allergen?

* I understand that it is my responsibility to notify and update the staff members of Midbar Kodesh Temple’s Early Childhood Center & Camp Shemesh of any existing or new allergies.

I understand that it is my responsibility to notify and update the staff members of Midbar Kodesh Temple’s Early Childhood Center & Camp Shemesh of any existing or new allergies.

Payment Information

* I would like to enroll my child for the Camp

I would like to enroll my child for the Camp $100 Non-Refundable Registration Fee
*

* Payment Options

* MKTECC Camp 2026 Payment Agreement *Balance for camp must be paid in full by June 20, 2026. *No refunds will be made for withdrawals after June 1, 2026. *No refunds or make-ups will be allowed for absences. **All Credit Card payments will incur a 3% fee

MKTECC Camp 2026 Payment Agreement *Balance for camp must be paid in full by June 20, 2026. *No refunds will be made for withdrawals after June 1, 2026. *No refunds or make-ups will be allowed for absences. **All Credit Card payments will incur a 3% fee

* I understand that I must notify MKT when my credit card expires or is cancelled and supply them with an updated number. If credit card is declined, a replacement must be given within 5 days or a $25 fee will be assessed on my account.

I understand that I must notify MKT when my credit card expires or is cancelled and supply them with an updated number. If credit card is declined, a replacement must be given within 5 days or a $25 fee will be assessed on my account. *

If you are satisfied with this form, awesome!
Just click submit, provide payment, and we will contact you if we have any questions.

Total Registration Fees Due

Wed, March 11 2026 22 Adar 5786

Home

Privacy Settings | Privacy Policy | Member Terms

©2026 All rights reserved. Find out more about ShulCloud