JAIS Summer Camp 2018

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Please keep all responses in English.

Please check the weeks of camp your child will be attending: *

Session 1: Sunday July 1st – Friday July 6th

Session 2: Sunday July 8th – Friday July 13th

Session 3: Sunday July 15th – Friday July 20th

Session 4: Sunday July 22nd– Friday July 27th

Required

Extended day Option: *

3:15 - 4:15, Sunday - Thursday

Yes - Every Day

Yes - Occasionally

Child's First Name: *

Child's Last Name *

Child's Date of Birth: *

Campers must be 3 years old by June 1st, 2018, and must be fully potty trained.

YYYY

Gender: *

Male

Female

Grade Completed in June 2018: *

School Attended:

Home Address: *

Mailing Address (If Different):

City and Neighborhood: *

Parent 1 First & Last Name: *

Parent 1 Email Address: *

Parent 1 Mobile Number: *

Parent 2 First & Last Name:

Parent 2 Email Address

Parent 2 Mobile Number

Emergency Contact Name (different from above): *

Emergency Contact Phone Number: *

Health Insurance Carrier *

Medical Conditions, Allergies, Medications:

Special Needs/Requests:

Child's Nationality: *

Language Spoken at Dinner Table: *

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. Staff will take photos throughout the duration of camp. I agree that pictures of my child may be used for the camp website, newsletters and promotional materials. No names or personal information will be used. *

I agree

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. *

I agree

Required

Additional Information

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