Camp Jersey Registration - 2017
Registration for all Programs - By registering, I give Jersey Productions permission to photograph, videotape and record my child while attending an educational program sponsored by Jersey Productions. I also give permission to use, publish and republish my child's image for promotional purposes with or without identification of my child by name.
Camper's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade *
(17/18 School Year)
Your answer
Gender *
Shirt Size *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Email *
for correspondence
Your answer
Which Session? *
Parent/Guardian Name *
Your answer
Parent/Guardian Phone *
Primary Number
Your answer
Emergency Contact Name/Relationship/Phone Number *
Your answer
Camper's Physician Name/Phone Number *
Your answer
Allergies/Medical Concerns *
Your answer
How did you hear about Camp Jersey Programs *
Your answer
How will you pay for this session? *
Please type any special codes for registration...
Your answer
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