Registration
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Our camps are $350/week and run from 10am to 3pm. We offer additional hours from 8-10am ($60/week) and 3-5pm ($50/week). You can indicate on this registration form if you'd like to be registered for either before or after care. A $100 deposit is due upon enrollment per camp and is non-refundable. Discounts: Sibling discount = $250/week for second child; $150/week for any additional children. Register before Valentines Day = $20 off total! Enroll in 4 camps, get the 5th free!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Guardian
Other
Parent 1
Parent 2
Renter
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Other/Non-Specified
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Other/Non-Specified
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Other/Non-Specified
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Other/Non-Specified
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
Female
Male
Other/Non-Specified
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Would you like to enroll in before care (8-10am) for Monday through Friday? The additional fee is $60 for the week.
*
Yes
No
Would you like to enroll in after care (3-5pm) for Monday through Thursday? The additional fee is $50 for the week.
*
Yes
No
Food/Medicine allergies or requirements, be specific with any instructions:
Additional Information:
Non-Refundable $100 Deposit
(Show-Hide Details)
I understand that my deposit is non-refundable and holds my camper's slot in the camp. I understand that this is not the full fee for camp, which is dependent on the number of children from my household enrolled and before/after care options. The deposit will be subtracted from total camp fees to be paid.
I've read the above and agree.
Full Payment Due Friday Before Camp
(Show-Hide Details)
I understand that I must have a balance of $0 for my child/ren to attend camp starting on Monday of a given camp, all camp fees are paid in advance.
I've read the above and agree.
No Nuts
(Show-Hide Details)
I will not pack food items containing nuts for my camper to protect their peers and teachers.
I've read the above and agree.
Emergencies
(Show-Hide Details)
I agree that JWSD staff may take action for any serious injuries or illnesses that would require calling 911 without express permission. I understand that after first contacting the appropriate heath services, I will be contacted immediately.
I've read the above and agree.
Availability
(Show-Hide Details)
I have a plan in place to retrieve my camper/s in case of emergency or serious behavioral worries/issues, such as aggression or extensive distress.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Exp Year:
*
2024
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Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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