JCC STEM Camp Registration Form

*Required - Child's name

*Required - Address

*Required - City

*Required - State

*Required - Zip code

*Required - Child's age

*Required - Upcoming grade

*Required - Female or male

Female

Male

Date of birth

*Required - Parent name

*Required - Address

*Required - City

*Required - State

Zip code

*Required - Parent email address

*Required - Daytime phone number

Additional phone number

Emergency contact and phone number

Names authorized to pick up camper

*Required - Medical practice

*Required - Physician name and phone number

Allergies or other health concerns

*Required - Session selectedApril 27

*Required - I have read and agree to the release/waiver termsI agree

After registration, please submit payment by clicking an option below:

VISA or Mastercard accepted