REGISTRATION FORM
PLEASE PRINT CLEARLY AND COMPLETE A SEPARATE REGISTRATION FORM FOR EACH FAMILY
(Registration can also be found online at tucsonjcc.org/camp)
CAMPER INFO
1. Full Name ___________________________________________________________________
Birthdate ______________ Gender __________ Grade (Fall ’19) ______________
Does child receive support services (OT, PT, Speech, Education, etc.)?*
Yes
No
Child resides with: _________________________________
2. Full Name ___________________________________________________________________
Birthdate ______________ Gender __________ Grade (Fall ’19) ______________
Does child receive support services (OT, PT, Speech, Education, etc.)?*
Yes
No
Child resides with: _________________________________
3. Full Name ___________________________________________________________________
Birthdate ______________ Gender __________ Grade (Fall ’19) ______________
Does child receive support services (OT, PT, Speech, Education, etc.)?*
Yes
No
Child resides with: _________________________________
*If checked “yes,” you will be contacted regarding your child’s specific needs to determine eligibility and to develop
support strategies to ensure his or her success at camp. Our goal is to be inclusive, proactive, and supportive
FAMILY INFO
MEMBER
GUEST
Parent/Guardian 1 _______________________________________________________________
Address _______________________________________________________________________
City/State/Zip ______________________________________________
Home#________-__________-________ Other#________-__________-________
Email ____________________________________________________
Parent/Guardian 2 _______________________________________________________________
Address _______________________________________________________________________
City/State/Zip ______________________________________________
Home#________-__________-________ Other#________-__________-________
Email ____________________________________________________
Child will not be released to anyone other than the above without written consent of parent or guardian
CAMP J 2019
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