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Jeff Lake Camp - 2018 Fantasy Day
audrey@jefflakecamp.com
973-347-1230
www.jefflakecamp.com

Cost: No charge. Space is limited. Completed application does not guarantee space or date of choice. Lunch and camp T-shirt will be provided. Parents remain with their camper from 10:30am-1pm. Please submit application from a computer (not from a phone). You will receive email confirmation of enrollment.

Fantasy Day Date *
Camper Information
Camper's Name (first, last) *
Your answer
Birthdate *
MM
/
DD
/
YYYY
School *
Your answer
Grade as of September 2019 *
Your answer
Food Allergies or Dietary Restrictions? *
Your answer
Home Address *
Your answer
Second Camper's Name (if applicable)
Your answer
Birthdate
MM
/
DD
/
YYYY
School
Your answer
Grade as of September 2019
Your answer
Food Allergies or Dietary Restrictions?
Your answer
Parent Information
Parent 1 Name *
Your answer
Home Address (if different from above)
Your answer
Home Telephone *
Your answer
Cell Phone *
Your answer
Email *
Your answer
Jeff Lake Alumni?
If yes, Years Attended
Your answer
If yes, Do you remember your team?
Parent 2 Name
Your answer
Home Address (if different from above)
Your answer
Home Telephone
Your answer
Cell Phone
Your answer
Email
Your answer
Jeff Lake Alumni?
If yes, Years Attended
Your answer
If yes, do you remember your team?
Other Siblings (not currently enrolled)
Name
Your answer
Birthdate
Your answer
Grade as of September 2019
Your answer
Name
Your answer
Birthdate
Your answer
Grade as of September 2019
Your answer
Currently Enrolled at Jeff Lake
Name
Your answer
Grade as of September 2019
Your answer
Name
Your answer
Grade as of September 2019
Your answer
Terms and Conditions
Permission is granted to Jeff Lake Camp to publish any photograph, video or likeness of my child(re) for advertising, commercial or any purpose. To the best of my knowledge The camper listed on this enrollment agreement is in sound physical and mental health and is able to participate in all camp activities. The Camp should have the exclusive right and secretion to make all decisions of the camper's fitness to participate in programs, including the right to dismiss the camper.
I have read and agree to the terms listed above *
Required
Signature *
Your answer
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