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
Signature Clear