General Form

Winter Camp 2024

Join JEP Juniors for a full week of incredible activities!
Participant's Name*

First NameLast Name
Birthday*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Grade*
School*
Does the participant attend Hebrew School?*
Hebrew School*
Synagogue Affiliation*
Does the participant have any allergies?
Please list participant's allergies:*
Mother's Name*

First NameLast Name
Mother's Email
Mother's Cell Phone Number

Area CodePhone Number
Is mother's home address the same as participant?
Mother's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Father's Name*

First NameLast Name
Father's Email
Father's Cell Phone Number

Area CodePhone Number
Is father's home address the same as participant?
Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parents' Marital Status
Other:*
Does the participant have a stepparent?
Stepparent via
Stepparent's Name*

First NameLast Name
Stepparent's Email
Stepparent's Cell Phone Number

Area CodePhone Number
Second Stepparent via
Second Stepparent's Name*

First NameLast Name
Second Stepparent's Email
Second Stepparent's Cell Phone Number

Area CodePhone Number
Please list participant's siblings and ages:
Emergency Contact (if parents unreachable)*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to Participant*
Would you like to purchase a JEP sweatshirt?
Sweatshirt Size
How did you hear about winter camp?
Other*
Name of Friend*
Important Information/Special Concerns:
I hereby give consent for my daughter to participate in the JEP Winter Camp and all its activities. I understand that JEP takes photos and videos during events and posts them to the JEP website and social media and give permission for my daughter’s photos to be included in promotional materials. I understand that if my child has a medical need, JEP will make a conscientious effort to notify my spouse or me. In the event that this is not possible, I give permission for JEP Girls of Maryland and its staff, or person designated, to make available to my child professional emergency medical care when such care is indicated. I give permission for my child to receive proper medical care by any doctor, nurse, paramedic, or member of a medical staff of a hospital.

By checking this box and printing my name below, I am giving my consent.
Parent's Name*

First NameLast Name
Email Address*
Date*

MonthDayYear
I am registering my daughter for

All 7 daysOnly a few days
I am registering my daughter for the following days:*

Monday, December 23Tuesday, December 24Wednesday, December 25Thursday, December 26Friday, December 27Monday, December 30Tuesday, December 31
Have a credit or discount code? Enter here.
Total

Total

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Winter Camp 2024