Camp Application

 

Jewish Community Center of Jersey Shore
100 Grant Avenue, Deal, NJ 07723
Phone: (732)531-9101

Parent #1 Name
Parent #1 Phone
Parent #2 Name
Parent #2 Phone
Parent Email

Summer Address Info

Street Address
City
State
Zip

Winter Address Info

Winter Address Street
Winter City
Winter State
Winter Zip

Emergency Contact Info

Emergency Contact #1 Name
Emergency Contact #1 Phone
Emergency Contact #2 Name
Emergency Contact #2 Phone

Number of Children
Pricing is in USD

 

Payment Information

Please Note: Refund Policy

First Name
Last Name
Address
City
State
Zip
Payment Method
Card Type
Card Owners Name
Card Number
CVV
Expiration Date
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