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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