JAIS Summer Camp 2017
Please keep all responses in English.
Please check the weeks of camp your child will be attending:
Required
Extended day Option:
3:15 - 4:15, Sunday - Thursday
Child's First Name:
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Child's Last Name
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Child's Date of Birth:
Campers must be 3 years old by June 1st, 2017, and be fully potty trained.
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Gender:
Grade Completed in June 2017:
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School Attended:
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Home Address:
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Mailing Address (If Different):
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City and Neighborhood:
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Parent 1 First & Last Name:
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Parent 1 Email Address:
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Parent 1 Mobile Number:
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Parent 2 First & Last Name:
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Parent 2 Email Address
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Parent 2 Mobile Number
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Emergency Contact Name (different from above):
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Emergency Contact Phone Number:
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Health Insurance Carrier
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Medical Conditions, Allergies, Medications:
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Special Needs/Requests:
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Child's Nationality:
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Language Spoken at Dinner Table:
Your answer
My child’s English is limited and will need extra assistance:
My Child's English is at a...
My Child Can Swim
I give permission for my child to attend the JAIS Summer Camp and to participate in all associated activities under proper supervision. I understand that any camper who does not abide by the rules and regulations established by JAIS Summer Camp is subject to dismissal without reimbursement or recourse. I understand that after June 1st no refunds will be made for withdrawal, failure to attend or incomplete attendance.
Required
Photo Release: Staff will take photos throughout the course of camp. I agree that pictures of my child may be used for the camp website, newsletters and printed advertisements. No names or personal information will be used.
Required
Emergency Authorization: All medical information pertaining to this registered camper is accurate and up to date. I hereby give permission to the medical personnel selected by the camp director to order x-rays and emergency treatment, with the understanding that my family will be notified as soon as possible. Parents are responsible for costs associated with medical services for their child. JAIS Summer Camp does not carry medical insurance for campers or students.
Required
Additional Information
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