Winter Camp Reservation
If you select per day/days, please fill in the day/days:
Child Information
Full Name
Hebrew Name
Age
Birth Date
School
Grade Entering
- Please Select -
Pre-K
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eight
Child's Cell Phone
Child's Email
Name of Sibling 1
Age of Sibling 1
Name of Sibling 2
Age of Sibling 2
Father's Information
Father's Name
Father's Religion
Father's Occupation
Father's Address
Father's E-mail
Father's Cell
Father's Facebook
Mother's Information
Mother's Name
Mother's Religion
Mother's Occupation
Mother's Address
Mother's Email
Mother's Cell
Mother's Facebook
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
I hereby give permission for my child to attend all field trips and outings sponsored by Jewish Kids Club.
Credit Card Information
Type
Visa
MC
Amex
Discover
Number
Expiration
Code
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Name
Address
Zip
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