Summer Jam Registration
June 11-August 3rd 9:00am - 12:00pm
Resurrection Assembly of God
1330 Keokuk Street
Summer Jam is a free summer program for any kid or teen under the age of 18.
Free breakfast & lunch will be provided on site, as well as educational activities, and community workshops.
Children younger than school age (K-12) must be accompanied by an adult or responsible older sibling/student.
All are welcome.
Student Name (First, Last)
What grade will your student be going into next year?
Preschool (Kid's aged preschool and below must be accompanied by an adult or responsible older sibling)
Any Other Pertinent Information?
Parent/Guardian Name (First, Last)
Emergency Contact Name (First, Last)
Emergency Contact Phone (First, Last)
Do We Have Permission To Post Pictures Of Your Student On Social Media?
In the case of an emergency do you give our staff/volunteers permission to seek appropriate medical help for your student?
Do you have a preferred hospital?
If at any point staff/volunteers deem it necessary for your student to go home (illness, behavior issues, etc.) it is your responsibility to pick them up, or give them permission to walk home. Do you understand and agree to these terms?
Does your child have permission to walk home?
No, I will provide transportation for my student.
If you have any questions please contact Abby Anderson at 319-333-6687 or at
Send me a copy of my responses.
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