2017 JCCNS Summer Camp Registration
Please email registrar@jccnursery.org if you have any questions or concerns with registration.
Parent/Guardian Information
Parent/Guardian Name
Your answer
Primary Phone Number (where you can be reached during the day)
Your answer
Parent/Guardian Name
Your answer
Phone Number
Your answer
Secondary Phone Number(s)
Your answer
Email Address
Your answer
Address of Residence
Your answer
Student Information
Student’s Name
Your answer
Student's Date of Birth
Your answer
Please list any allergies which affect your child.
Your answer
Does your child have any medical or developmental needs we should be aware of?
Your answer
What is your child's reaction to new situations/people?
Your answer
Has your child had previous preschool or daycare experience?
Is your child potty-trained?
Emergency Contact Information
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Authorized Pick up
Please list names of individuals who are allowed to pick up your child from camp
Your answer
Week Options
Choose which session(s) your child will attend for each camp week. Camp is held on Tuesdays, Wednesdays, Thursdays.
Week 1: Science Week (July 11, 12, 13)
Week 2: Nature & Camping Week (July 18, 19, 20)
Week 3: Art Week (July 25, 26, 27)
Week 4: Super Hero Week (August 1, 2, 3)
Week 5: Royalty Week (August 8, 9, 10)
Week 6: Dinosaur Week (August 15, 16, 17)
Parent/Guardian Agreements
By typing my name in the space provided, I understand that I agree to the terms and conditions laid out in the JCCNS Parent Contract. (See: https://docs.google.com/document/d/1mrcPP4llZGxgzpTGiDRfUbTDMb_p3V8vy2ynbDkDpPM/edit?usp=sharing)
Your answer
You've reached the end of the form. Our registrar, Spring Younkin, will be in touch shortly to confirm your registration. You'll receive more information on what to bring to camp shortly before your student's first week.
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