2019 JCCNS Summer Camp Registration
Please email registrar@jccnursery.org if you have any questions or concerns with registration.
Email address *
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 other than parents (such as grandparents, babysitters, etc.)
Your answer
Week Options
Choose which session(s) your child will attend for each camp week. Camp is held on Mondays, Tuesdays, Wednesdays, and Thursdays 8:30 a.m. - 12 p.m. Sessions are $100/week. Discount of 7% ($93/wk) for enrollment of 3 or more weeks, per child.
Add my child to the waitlist for: Ocean Week (July 8, 9, 10, 11)
Add my child to the waitlist for: Camping Week (July 15, 16, 17, 18)
Add my child to the waitlist for: MAD Scientist Week (July 22, 23, 24, 25)
Add my child to the waitlist for: Outer Space Week (July 29, 30, 31, August 1)
Add my child to the waitlist for: Around the World Week (August 5, 6, 7, 8)
Add my child to the waitlist for: Author Week (August 12, 13, 14, 15)
How did you hear about the JCCNS? *
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 (https://docs.google.com/document/d/1d8iSxPcOiRhnhfNbC7pzmJf3VaJVggxJtJzsZ28JirQ/edit?usp=sharing). *
Your answer
You've reached the end of the form. We will be in touch shortly to confirm your registration. You'll receive more information on what to bring to camp before your student's first week.
The Jewish Community Center Nursery School of State College, Inc. is a 501(c)(3) and admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service