ICJC 2019 Summer Camp - Registration Form
CHILD INFORMATION:
Please fill info for all the children in the family you would like to register.
Child 1 Name
*
First Name
Last Name
Age
*
Please Select
4
5
6
7
8
9
10
11
12
Next year grade
*
Please Select
Pre K
KG
1 st
2 nd
3 rd
4 th
5 th
6 th
7 th
Gender
*
Male
Female
T-shirt size
*
XS
S
M
L
XL
XXL
Share pictures of your children's activities on FB?
*
Yes
No
Any allergies
provide details
Child 2 Name
First Name
Last Name
Age
4
5
6
7
8
9
10
11
12
Next year grade
Pre K
KG
1 st
2 nd
3 rd
4 th
5 th
6 th
7 th
Gender
Male
Female
T-shirt size
XS
S
M
L
XL
XXL
Share pictures of your children's activities on FB?
Yes
No
Any allergies
provide details
Child 3 Name
First Name
Last Name
Age
4
5
6
7
8
9
10
11
12
Next year grade
Pre K
KG
1 st
2 nd
3 rd
4 th
5 th
6 th
7 th
Gender
Male
Female
T-shirt size
XS
S
M
L
XL
XXL
Share pictures of your children's activities on FB?
Yes
No
Any allergies
provide details
Child 4 Name
First Name
Last Name
Age
4
5
6
7
8
9
10
11
12
Next year grade
Pre K
KG
1 st
2 nd
3 rd
4 th
5 th
6 th
7 th
Gender
Male
Female
T-shirt size
XS
S
M
L
XL
XXL
Share pictures of your children's activities on FB?
Yes
No
Any allergies
provide details
PARENT INFORMATION:
Primary Contact Name
*
First Name
Last Name
Primary Cell Phone Number
*
-
Area Code
Phone Number
Primary Email Address
*
Secondary Contact Name
*
First Name
Last Name
Secondary Cell Phone Number
*
-
Area Code
Phone Number
Secondary Email Address
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MEDICAL INFORMATION
Medical Concerns, excluding food allergies (use NA if there are none)
*
Any other info/comments/special requests
E-SIGNATURE - Please SIGN BELOW TO ACKNOWLEDGE that all the above info provided is CORRECT and A RELEASE OF LIABILITY FORM is required for all children registered to the SUMMER CAMP. All Payments are Non-Refundable. If any payment is DECLINED or RETURNED, Registration will be CANCELLED from Summer Camp and the spot will be given to the next in the waiting list.
Please pay here to complete the Registration.
*
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SUMMER CAMP FEE
$
200.00
Select Number of Children registered
0
1
2
3
4
Total
$
0.00
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