JPProclaim 2018 Summer Camp Application

June 11th through August 17th

-The Registration Deadline is JUNE 3rd OR when all slots are filled.
Your child must be 5 years old on or before June 11th and NO older than 12 years old Your child's welfare is of the utmost importance. In case of emergency, (if the parent or designees cannot be reached) we will act upon our best judgment.

The hours of operation for JSPBSC are from 7:00A.M. -5:30 P.M. Monday through Friday. A late incident will be charged per incident, per child, for those who are picked up after 5:30P.M. unless prior arrangements have been made.

In addition, you will be notified by phone of any disciplinary problems we have with your child, and we will also follow-up with a letter. Continued discipline problems may cause your child to be dismissed from the camp program. Registration is on a first-come, first-serve basis. All camp fees ($650.00) are due and payable in full at the time of registration and must be paid my MONEY ORDER, CREDIT CARD, or CASH only!

There will be NO REFUND of camp fees.

By signing, I state that I understand the policy as mentioned above.

General Information (one application per child):

Sex *

Shirt Size

Emergency Contact Information:
Name #1: Relationship: Phone:
Name #2: Relationship: Phone:
Name #3: Relationship: Phone:

Medical Information:

Does your child have any chronic illness, allergies, mental or physical limitations?

If yes please explain:

Insurance Information: