Camp Warrior Registration Form

Camp Warrior Registration

Offering Adventures in Reading, Math, and Science and other Summer Fun
Dates: June 3-July 12

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

Ages: 3-12

Includes Breakfast, Lunch, and a full day of Learning and Adventure.

Registration is $25.00. Due at registration. This fee is non-refundable.

Weekly fee $140.00

One time Payment: $750.00 (Save $90)

Register by May 24, 2024
Student Information
Child's Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
Gender*

MaleFemale
Grade COMPLETED in May 2024*

Jr. PreK (age 3)PreK (age 4)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade
Address*

Street Address

Apartment/Building Number

CityState

Zip Code
Insurance Card (Please upload a picture of the front and back of the card)

Browse Files

Cancelof
Allergies*
Permission to Treat*

YesNo
Over the counter Medication Permitted:*

Children's TylenolChildren's MotrinPepto-BismolTumsZyrtecBenadrylCortisol CreamAntibacterial Ointment
Special Medication*
School child attended during 2023/2024 school year?*
Any Academic, social or social-emotional concerns?*
Second Child's Name

First NameLast Name
Age
Birth Date

MonthDayYear
Gender

MaleFemale
Grade COMPLETED in May 2024

Jr. PreK (age 3)PreK (age 4)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade
Address

Street Address

Apartment/Building Number

CityState

Zip Code
Insurance Card (Please upload a picture of the front and back of the card)

Browse Files

Cancelof
Allergies
Permission to Treat

YesNo
Over the counter Medication Permitted:

Children's TylenolChildren's MotrinPepto-BismolTumsZyrtecBenadrylCortisol CreamAntibacterial Ointment
Special Medication
School child attended during 2023/2024 school year?
Any Academic, social or social-emotional concerns?
Third Child's Name

First NameLast Name
Age
Birth Date

MonthDayYear
Gender

MaleFemale
Grade COMPLETED in May 2024

Jr. PreK (age 3)PreK (age 4)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade
Address

Street Address

Apartment/Building Number

CityState

Zip Code
Insurance Card (Please upload a picture of the front and back of the card)

Browse Files

Cancelof
Allergies
Permission to Treat

YesNo
Over the counter Medication Permitted:

Children's TylenolChildren's MotrinPepto-BismolTumsZyrtecBenadrylCortisol CreamAntibacterial Ointment
Special Medication
School child attended during 2023/2024 school year?
Any Academic, social or social-emotional concerns?
Parent/Guardian Information
Name*

First NameLast Name
Relationship*
Cell Number*

Area CodePhone Number
Work Number

Area CodePhone Number
E-mail*
Confirm E-mail*
example@example.com
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
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 $25.00 per child. This fee is non-refundable. The registration fee must be paid when the application is submitted.

My Products*

Registration Fee

$25.00 Quantity

Weekly Camp Fee

$140.00 QuantityHow Many Weeks

Full Camp Fee ($50.00 discount)

$750.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

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.
Signature*

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Camp Warrior Registration

Payment Information

Payment Methods