Child's Information
Please fill out your child's information below
Child's Full Name
Birth Date
Grade Entering in Fall
Child 1
Child 2
Child 3
Child 4
Child 5
Do you have additional children in your house you would like to register?
Yes
No
Parent or Legal Guardian Information
Parent/Legal Guardian
*
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation
*
Phone
*
-
Area Code
Phone Number
Parent /Legal Guardian 2
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation 2
Phone 2
-
Area Code
Phone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)
*
Emergency Number
*
-
Area Code
Phone Number
Camper Photo Release
I agree that photos of my child can be taken at this event and used for PJ Library and JCC marketing purposes.
Yes
No
Submit
Should be Empty: