Vacation Program

Vacation Program

2025-26 Parent Permission Waiver
Participant's Name

First NameLast Name
Are you a JCC MetroWest member?
Participant's Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant's School
Participant's Grade
Parent/Guardian A Name

First NameLast Name
Parent/Guardian A Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian A Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian A Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian A Email
example@example.com
Parent/Guardian B Name

First NameLast Name
Parent/Guardian B Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian B Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian B Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian B Email
example@example.com
EMERGENCY CONTACT INFOMATION
Emergency Contact Name

First NameLast Name
Relationship
Day Phone
Please enter a valid phone number.Format: (000) 000-0000.
Doctor's Name
Doctor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any allergies or medical needs
Person A

First NameLast Name
Relationship to Person A
Person B

First NameLast Name
Relationship to Person B
Time: 9:00am – 5:00pm
Fee: Member: $95/day or Non-Member: $110/day

Before Care: M-F starting at 8am ($10 fee)
After Care: M-Th until 6:00pm & Fridays until 5:45pm ($10 fee)
Please select all program dates that apply:
Do you require before/after care?
Which dates do you require before/after care?
Please Check All

Participation in any JCC MetroWest activity and use of any recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities to be conducted by the JCC MetroWest I/we, as an individual or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his/her/our participation in any activities or use of any facilities at or conducted by the JCC MetroWest.
Should be Empty:

Vacation Program

EMERGENCY CONTACT INFOMATION