Register

CHILD'S INFORMATION:

Name*

First Last

Jewish Name:*

Sex*

Male
Female

Age now*

How old will child be on 9/1/24?*

Date of Birth*

FAMILY INFORMATION:

Mother's Information

Mother's Name*

First Last

Jewish?*

Yes
No

If Yes, by:*

Birth
Choice

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

Father's Information

Father's Name

First Last

Jewish?

Yes
No

If Yes, by:

Birth
Choice

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Email

Child lives with*

Mother
Father
Both
Other

Parents or gaurdians are*

Married
Separated
Divorced
Single

Who has legal custody?*

Please send all Camp correspondence to:*

Mother
Father
Other

Previous programs attended?*

Is there any special situation or characteristic concerning your child that is important for the camp to be aware of?*

Ex; Intellectual| emotional | physical | developmental |

Select Schedule

Registration of $100 and security fee of $250 are due upon registration. After submitting this form please follow the link to the payment page.

Credit Card

Tuition policy

I/ We agree to pay according to the selection indicated above. If sufficient funds are not available or if the account has been closed, my/our account will be charged $25 for each transaction that could not be processed. I/We agree that my/our child(ren) will not be allowed to attend camp unless payment is kept current. I/We understand that my/our child(ren) will be unable to attend DJC unless and until the state required good health and immunization certification is received from a physician. I/We understand that my/our child(ren) are enrolled for the specified time. The school cannot issue refunds or credits for illness, holidays or family vacations. In the event that the camp is closed due to or resulting from a weather emergency or other unforeseen circumstance, there will be no make-up days, refunds or credits for days that school is not in session. In the event of early withdrawal, you are responsible for the full amount. No refunds will be given. The registration fees are non-refundable.

Signature*

Print Name*

Please upload your waiver, copy of child’s birth certificate, copy of parents’ Government Issued Photo ID, Current Medical Forms and Immunization Records for child. If you are a current DJP student please confirm with the office that all your paper work is up to date.

Drop files here or

The DJC CAMP registration form

CHILD'S INFORMATION:

FAMILY INFORMATION:

Mother's Information

Father's Information

Tuition policy