Kids Day Off Camp Registration JASC

JASC Day Camp Registration Form
You can register AND pay online using this form. Please complete your registration and use the payment buttons below to pay your registration fee now online.

If you prefer to register online but pay by check sent to the JASC office, please click on the link below:

Register and pay by check
Parent/Guardian Name*

First NameLast Name
E-mail*
example@example.com
Best phone number to reach parent/guardian*
This is phone my

HomeWorkCell/Mobile
What is your preferred form of contact - select all that apply:

TextEmailPhone callOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a JASC member?

Yes, I am a JASC memberNo, I am not a JASC Member

Name of Student #1

First NameLast Name
Date of birth of Student #1

MonthDayYear
Date
List all food allergies Student #1 has:
Camp selection for Student #1
Traditional Japanese Game Camp on Monday, October 9, 2023

Member - $40 (code: gamecampm1)Non-Member - $45 (code: gamecampnm1)After camp care (1 pm - 3 pm) - $15 (code: caregc1)Clear Selection
2024 New Year's Kid's Camp on Monday, January 15, 2024

Member - $40 (code: nycampm1)Non-Member - $45 (code: nycampnm1)After camp care (1 pm - 3 pm) - $15 (code: careny1)Clear Selection

Name of Student #2 (if applicable)

First NameLast Name
Date of birth of Student #2 (if applicable)

MonthDayYear
Date
List all food allergies Student #2 has:
Camp selection for Student #2
Traditional Japanese Game Camp on Monday, October 9, 2023

Member - $40 (code: gamecampm2)Non-Member - $45 (code: gamecampnm2)After camp care (1 pm - 3 pm) - $15 (code: caregc2)Clear Selection
2024 New Year's Kid's Camp on Monday, January 15, 2024

Member - $40 (code: nycampm2)Non-Member - $45 (code: nycampnm2)After camp care (1 pm - 3 pm) - $15 (code: careny2)Clear Selection

Name of Student #3 (if applicable)

First NameLast Name
Date of birth of Student #3 (if applicable)

MonthDayYear
Date
List all food allergies Student #3 has:
Camp selection for Student #3
Traditional Japanese Game Camp on Monday, October 9, 2023

Member - $40 (code: gamecampm3)Non-Member - $45 (code: gamecampnm3)After camp care (1 pm - 3 pm) - $15 (code: caregc3)Clear Selection
2024 New Year's Kid's Camp on Monday, January 15, 2024

Member - $40 (code: nycampm3)Non-Member - $45 (code: nycampnm3)After camp care (1 pm - 3 pm) - $15 (code: careny3)Clear Selection
If you want to register additional campers beyond the three listed above, please fill out this form completely, submit it, and fill out a second form for your additional campers. Thank you.

JASC Day Camp Registration Form