Club JCA-10 Summer Camp Registration

Attendee Name

First NameLast Name

Date of Birth

Date

2026-27 School Year Grade Level:

Any Allergies, Conditions, or Medications? (Feel free to contact us privately if desired)

Parent/Guardian Name

First NameLast Name

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Email

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Attendee

Please select which dates the participant is likely to attend. Full event descriptions with times can be found at the following link: https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:93a477f8-5632-4052-b457-fcb9099cdfb6

Is the attendee interested in taking a plane ride in a Cessna 172? (Cost: $20 per attendee)

Airplane Ride Registration Fee

Summer Camp Registration: AIRPLANE RIDE

ONLY pay this registration fee of $20 if the attendee plans to take an airplane ride during Club JCA-10. Club JCA-10 is FREE for attendees that are not planning to fly. Airplane rides are scheduled for July 30 with a rain date of August 6. Attendees will be organized into groups of 3 for a 20-25 minute airplane ride.

$20.00

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Club JCA-10 Summer Camp Registration

Attendee Information

Parent/Guardian Contact Information

Emergency Contact Information

Event Interest

Airplane Ride Registration Fee

Payment Methods

Please contact Emily Hackler (Jasper Co. Airport Manager) at info@jaspercountyairport.com or (219) 866-2100 with any questions or concerns.