2019 JCC Summer Camp Guide

315-445-2360 | www.jccsyr.org
5655 Thompson Rd., DeWitt, NY 13214
2019 School-Age
and Teen Camp Registration
• Carefully read the registration and
general camp information.
• Please print neatly.
• Mailing and billing will be sent to the
camper’s address.
• No third-party billing.
• Many camps have grade and equipment
requirements. Please check program
descriptions before completing
registration.
• There will be a $20 fee for any changes
made after initial registration.
Use one form per child.
No refunds after May 24.
CAMPER INFORMATION
Last Name
First Name
Address
Date of Birth
City State Zip Age
School Grade Entering (2019-20)
T-Shirt Size (check one) Youth: q 6-8 q 10-12 q 14-16 Adult: q S q M q L
Child lives with q Parent #1/Guardian q Parent #2/Guardian q Both
PARENT #1/GUARDIAN INFORMATION
Last Name
First Name
Email
Date of Birth
Home Phone Cell Phone Work Phone
Occupation
PARENT #2/GUARDIAN INFORMATION
Last Name
First Name
Email
Date of Birth
Home Phone Cell Phone Work Phone
Occupation
EMERGENCY CONTACT INFORMATION (other than parents—must be local)
#1 – Last Name First Name
Phone Alt. Phone Relationship
#2 – Last Name First Name
Phone Alt. Phone Relationship
BUS TRANSPORTATION
If the JCC will be busing you child, please refer to
the bus stops on page 5 and indicate the AM and
PM stops most convenient for you.
AM ________________ PM ________________
HOW DID YOU HEAR ABOUT US?
Please check all that apply.
q Friend, neighbor or
JCC member
q JCC mailings
q Attended camp
before
q Facebook
q Twitter
q Instagram
q Post-Standard
q Family Times
q Syracuse Parent
q Jewish Observer
q Other:
ORDER EXTRA T-SHIRTS
q Yes! Please order my son/daughter the
following extra camp T-shirts at $8 each.
Number of shirts ______ x $8 = $____________
Size (check one)
Youth: q 6-8 q 10-12 q 14-16
Adult: q S q M q L
Please transfer your total number of extra T-shirts
and dollar amount above on to the other side of
this form (page 9) as part of your total payment
amount. Remember—every camper will receive a
free T-shirt at the start of his/her first session.
SIGNATURE
My son/daughter has my permission to go on field trips during the time camp is in session. I understand that I will be informed of the exact date, time and
destination of each trip in advance of departure. Field trips may be weather permitting. I give permission for my child to go on trips with persons designated by
the JCC Camp Directors.
I give permission for photographs of my son/daughter to be used in any camp publicity or promotion.
___________________________________________________ ____________________________________________________ ____________________
Camper’s Name Parent/Guardian Signature Date
FOR OFFICE
USE ONLY
Payment Received _________________ Amount _______________ Date _____________ Initials ____________
Class List ________________________ Tracking _______________ Daxko ____________
10 JCC of Syracuse | 2019 Summer Camp Guide