Clone of 2026 Jericho Summer Learning Program Registration Form

Registration for Jericho Discovery Program - Summer 2026

9th -12th Grade
Enter the email address you used to sign up for ALP/SLP in the past
Family ID*
Click here to register for a Family ID:

https://form.jotform.com/260092140529148

Preferred language for camp communications:*

EnglishSpanishPortuguese
Location: 22 Maple Avenue, Danbury

The Discovery Program will run from July 6 - August 13, 2026 and is open Monday - Thursday. NOTE - there is no Discovery Program on Fridays. This year, we are offering the Discovery Program in 2 sessions:
- Session 1: July 6 - July 23
- Session 2: July 27 - August 13
The cost per session will be $175 or $350 for both sessions.
My child will attend the following sessions of camp:*
prevnext( X )
Session 1July 6 - July 23
$175.00

Session 2July 27 - August 13
$175.00

Total

$0.00

Student Information
Student Name*

First NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
What is the Name of the School student will attend in the Fall 2026*
Ellsworth, Broadview, etc.
Grade student will enter Fall 2026*
Ethnicity*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian #1 Information
Parent #1 Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Address If Different From Student

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2

First NameLast Name
Parent #2 Cell Number
Parent #2 E-mail
example@example.com
Parent #2 Address If Different From Student

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information - Please supply 2 contacts OTHER than parents.
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Do you authorize us to release your child to the designated emergency contact person?*

YesNo
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Do you authorize us to release your child to the designated emergency contact person?*

YesNo

General releases and permission

Photo/Video Release
I grant/deny permission to Jericho Partnership, Inc. to use my child's image, as indicated by my selection below. This authorization includes, but is not limited to, the display, distribution, publication, and transmission of photographs, images, and/or videos of my child for use in various materials, including printed publications such as brochures and newsletters, as well as digital media such as videos and images on the Jericho Partnership website.*

Grant unrestricted permission for my child’s image as stated above.Deny permission to use my child’s image at all.
Transportation Permission
I authorize my child to be transported as needed in a Jericho Partnership, Inc. van or a rented school bus. By signing below, I release and discharge Jericho Partnership, Inc., along with its officers, directors, employees, volunteers, and partners, from any and all liability, loss, damage, or claims that may arise in connection with this transportation. I understand that Jericho Partnership, Inc. is not responsible for any injuries, accidents, or loss of valuables that may occur while my child is being transported.*

YesNo
Informed Consent and Acknowledgement
I hereby give my consent for my child to participate in all activities organized by the Jericho Summer Learning Program during the selected camp. I acknowledge and assume all risks and hazards associated with these activities and release, absolve, and hold harmless Jericho Partnership, along with its officers, agents, and representatives, from any liability for injuries sustained by my child while traveling to, participating in, or returning from camp sessions. In the event of injury, I waive all claims against Jericho Partnership, including its coaches, affiliates, participants, sponsoring agencies, advertisers, and, if applicable, the owners and lessors of the premises used for the event.*

Consent and acknowledgment given
Walkers
By checking below, I give my consent for my child(ren) to walk home or to another designated destination of my choosing after their daily participation in the Summer Learning Program. I acknowledge and accept full responsibility for my child’s safety and any risks they may encounter once they have departed from the Program each day.*

No, my child will NOT walk home.Yes, my child may walk home.

Field Trips
I give permission for my child to participate in all field trips scheduled during the weeks they attend camp.*

YesNo
I understand that my child is expected to behave responsibly and to follow Jericho's discipline code and policies*

YesNo

Behavior and Discipline Policy
At Jericho’s Summer Learning Program, we believe in fostering a positive and respectful environment where children can learn and grow. Our approach to behavior management emphasizes understanding, guidance, and encouragement rather than punishment. This section outlines the strategies and principles we use to guide children's behavior.

Guiding Principles

1. Respect and Empathy: All children are treated with respect and encouraged to show kindness to others.

2. Consistency: Clear and consistent boundaries help children understand expectations and feel secure.

3. Positive Reinforcement: Good behavior is acknowledged and rewarded through praise and encouragement.

4. Problem-Solving: We encourage children to think critically and find solutions to conflicts with guidance.

Behavior Guidance Strategies

1. Setting Clear Expectations:

○ We communicate age-appropriate rules and routines in a positive manner.

○ Rules are simple and consistently reinforced (e.g., "We use gentle hands," "We take turns").

2. Modeling Appropriate Behavior:

○ Teachers and staff model kindness, patience, and problem-solving techniques.

3. Redirection:

○ When inappropriate behavior occurs, children are gently redirected toward positive activities.

4. Encouraging Communication:

○ We teach children to express their feelings and needs using words or other appropriate methods.

5. Natural Consequences:

○ Whenever possible, children experience natural consequences of their actions (e.g.,cleaning up after spilling).

6. Time to Reflect:

○ If needed, children may be given a brief, supervised “cool-down” period to reflect on their actions. This is not a punishment but an opportunity for self-regulation.
Prohibited Practices

To ensure a nurturing and safe environment, the following practices are strictly prohibited:

● Corporal punishment (e.g., spanking, hitting)

● Verbal abuse, ridicule, or harsh language

● Withholding food, rest, or comfort as a form of discipline

● Isolating or ignoring children as punishment

Handling Challenging Behaviors

1. Observation and Documentation:

○ Teachers observe and document recurring challenging behaviors to identify triggers or patterns.

2. Collaboration with Parents:

○ Parents will be informed promptly if a behavior persists.

○ Together, we will create an action plan to address the behavior in a consistent and supportive manner.

3. Individualized Support Plans:

○ If needed, a child may receive individualized attention or referrals for additional support (e.g., child psychologists, therapists).

Conflict Resolution and Peer Disputes

When children have conflicts with peers, we guide them through the following steps:

1. Calmly stop any unsafe behavior.

2. Help children express their feelings and listen to one another.

3. Brainstorm solutions together.

4. Encourage reconciliation and guide them to resume play cooperatively.

Parental Communication

We maintain open communication with parents regarding their child's behavior, both positive and challenging. Updates are shared through:

● Daily notes or conversations at pick-up/drop-off.

● Scheduled parent-teacher conferences.

● Immediate contact for serious incidents or safety concerns.

By working together, we aim to nurture children’s social-emotional skills, helping them to develop self-discipline, empathy, and respect for others.
Parent Acknowledgment of Behavior and Discipline Policy

I acknowledge that I have received, reviewed, and understand the Behavior and Discipline Policy of Jericho Partnership's Summer Learning Program. I agree to support these guidelines and collaborate with the staff to promote a positive and nurturing environment for my child. I understand the center's approach to behavior management and agree to partner with the program in addressing any behavioral concerns should they arise. By signing this form, I confirm that I have read the policy and will adhere to the practices outlined in it.
Parent's Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Signature

Clear

Parent Contract/Terms of Agreement
1. I understand that the program starts at 8:30 am. I understand that if my child arrives after 9:00 am, my child will not be served breakfast for that day.
2. I understand that the program ends at 3:30 pm and I agree to pick-up my child on-time. I agree to call the program and let them know if I cannot be on time for whatever reason. Please note that repeat instances of late pick-up may be subject to an additional fee and/or suspension the following day.
  1. If I have registered for Extended Care, I agree to pick-up my child by 5:30 pm.
3. Anyone picking up my child must be at least 18 years of age (unless specifically authorized by me) and should be prepared to show a photo ID when picking up a child from the program.
4. I acknowledge the possibility that my son/ daughter may be injured as a result of his/her participation in program activities. I will not make the Jericho Summer Learning Program, its instructors, administrators or personnel responsible for any injury that my child suffers as a result of these activities.
5. I give permission to the Jericho Summer Learning Program to ask my child to complete surveys evaluating various aspects of the summer program. I understand that all information collected regarding my child will be kept confidential.
6. In case of personal injury to my child(ren), I hereby waive any and all claims against any person who on behalf of the Jericho Summer Learning Program is involved in the transportation of my child(ren).
7. I hereby consent to emergency medical treatment of my child(ren) to assure prompt treatment and prevention of undue delay, and I will be responsible for ambulance and medical costs.
8. I understand that emergency and health information in the camp records must be kept current. I will advise the Director of Camp in writing of any changes in my information.
9. If my child(ren) becomes ill, either an authorized person or I will be called to pick up the child(ren). (must be 18 or older)
10. In order to maintain a safe and fun program, I will work with program staff to ensure proper behavior. Children who exhibit behavior negative to the program may require a parent meeting and the development of a Behavior Plan. Any persistent or severe behavior problems by my child may result in suspension or termination from the program; funds will not be returned. In good faith the program makes every effort to the continued enrollment of the children.
11. Parents and Guardians are expected to show respectful behavior at all times while in the Jericho Summer Learning Program, on field trips or special events. Any disrespectful behavior including foul language, yelling, intimidation of children or staff, or other threatening type behavior may result in termination of my family from the program.
I have fully read, understood and accept the above policies and I agree to abide by all program policies. I recognize the Jericho Summer Learning Program is relying on my acceptance in permitting my child(ren) to participate in the Jericho Summer Learning Program activities.
Today's Date*

MonthDayYear
Date
Parent Signature*

Clear

Please note that we require a current physical (dated within 3 years) on file for each student enrolled in the program. You may attach a copy below or drop off at the office. We MUST have a copy of the physical before your child will be granted permission to attend the Program.
Attach copy of physical here:

Cancelof
You may attach copies of any other required documents here (MEDICATION FORMS, ETC.):

Cancelof
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.

The above named child has my permission to attend this program and take trips as mentioned above.
Parent's Name*

First NameLast Name
Parent Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Registration for Jericho Discovery Program - Summer 2026

Health Information

General releases and permission

Field Trips

Behavior and Discipline Policy

Please note that we require a current physical (dated within 3 years) on file for each student enrolled in the program. You may attach a copy below or drop off at the office. We MUST have a copy of the physical before your child will be granted permission to attend the Program.