Post-Camp Registration Form

Jewish Community Center of Jersey Shore 100 Grant Avenue, Deal, NJ 07723 Phone: (732)531-9101 POST CAMP DATES: Tuesday August 25- Friday August 28 9:30-3:00PM
Parent #1 Name
Parent #1 Phone
Parent #2 Name
Parent #2 Phone
Parent Email
Summer Address Info
Street Address
City
State
Zip
Emergency Contact Info
Emergency Contact #1 Name
Emergency Contact #1 Phone
Emergency Contact #2 Name
Emergency Contact #2 Phone
$450 Per Child 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
Price includes lunch, snacks and beverages. Your signature below authorizes the JCC of the Jersey Shore to secure from any licensed, hospital, physician or medical personnel any treatment deemed necessary for me or my minor child's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I understand that this authorization includes transporting my child by ambulance if necessary to the nearest medical treatment facility if I am unable to be reached first. I will not lay claims of liability or take legal action against the JCC or its staff. I also give the JCC permission to take any photographs of my child during the camp day and use them in any flyer or advertisement.
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