STEAM Summer Camp Registration "*" indicates required fields Camper's Current Grade*VPKKindergarden1st2nd3rd4th5thCamper Grade for 2024-2025*Kindergarden1st2nd3rd4th5th6thCamper InformationName* First Name Last Name Gender*FemaleMaleDate of Birth* MM slash DD slash YYYY Would you like to register another camper?NoYesCamper 2 Current GradeVPKKindergarden1st2nd3rd4th5thCamper 2 Grade for 2024-2025Kindergarden1st2nd3rd4th5thName First Name Last Name GenderFemaleMaleDate of Birth MM slash DD slash YYYY Parent InformationName* First Name Last Name Email* Emergency Contact Number*How did you hear about Jack & Jill Center's STEAM Summer Camp??* Media Consent:*I hereby grant permission for the Jack & Jill Center STEAM Summer Camp to mention, feature or describe my child/children in printed publications, news stories and/or features about the Center and its activities. I further grant permission to use images of my child/children in printed publications, video, social media, press releases and/or the Jack & Jill website without further consideration. I acknowledge that Jack & Jill has the right to crop or treat photographs at its discretion, and understand that Jack & Jill and/or outside agencies may choose not to use the photo at this time, but may do so at its own discretion at a later date.YesNoField Trip Consent:*I hearby grant permission for my child/children to participate in STEAM Summer Camp field trips and activities off-campus. I understand that I will be notified in advance of each trip and can opt out on a trip by trip basis.YesNoConsent* I agree to the following:I understand that I am responsible for dropping off and picking up my student (s) within the designated camp hours and fees will be charged if I drop off earlier or pick up later than those times.Consent* I agree to the following:I understand that any weekly camp fees I owe (if applicable) will be billed to me via my account with the school. For questions about billing, please email Ms. Kathy at kcapobianco@jackandjillcenter.org.Consent* I agree to the following:By submitting this form, I indicate that my student (s) will be attending Summer Camp at The Madelaine Halmos Academy and I accept responsibility for any fees incurred as a result of their attendance.Full Name of Parent/Guardian Submitting Form:* Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
