Summer Camp Registration Form

Camp Warrior Registration

Offering Adventures in Math, Science and ELA and other Summer Fun
Dates: June 5-July 14

Time: 7:30a.m. - 4:00 p.m.

Ages: 3-12

Registration $35.00 for JCA Warriors; $50.00 for non-JCA Warriors. Due at time of registration. This fee is non-refundable.

Weekly fee $150.00 Includes breakfast and lunch.

Due by May 22
Student Information
Student's Name*

First NameLast Name
Grade COMPLETED in May 2023*

Jr. Pre-K (3 year olds)Pre-K (4 year olds)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Birth Date*

MonthDayYear
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Grade COMPLETED in May 2023

Jr. Pre-K (3 year olds)Pre-K (4 year olds)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Birth Date

MonthDayYear
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Grade COMPLETED in May 2023

Jr. Pre-K (3 year olds)Pre-K (4 year olds)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Confirm E-mail*
example@example.com
What STATE & COUNTY does your child(ren) attend school in?*
Emergency Information Other than the name listed above
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Jehovah-Jireh Christian Academy during Camp Warrior. Jehovah-Jireh Christian Academy is not responsible for increased grades in school. However, we do guarantee providing each student with developmentally appropriate tasks, strategic lessons, and researched based content to improve and/or enhance their skills in reading, writing, math and science.
*

AgreeI do not agree
Media Disclosure Jehovah-Jireh Christian Academy may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on Jehovah-Jireh Christian Academy's Website, Instagram, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at Camp Warrior. You can also follow us on Instagram and Facebook to capture all of the pictures yourself!
Type a question*

AgreeI do not agree
Payment Information

Payment includes registration fee of $35.00 per child for JCA Warriors and $50.00 per child for non-JCA Warriors. This fee is non-refundable. Students are not enrolled until registration fee is paid. $150.00 for the first week of camp is due May 22. You can submit payments via CashApp $JCAWarriors or Zelle dhricks@me.com
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Camp Warrior Registration

Payment Information