Jumpin' for Joy Waitlist - St. Mary's Dominican High School

Jumpin' for Joy - Waitlist Registration Form

Camper Information
Camper's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
(###)###-####
Current Elementary School
School Attending '25-'26
Grade Level ('25-'26)*
Date of Birth*
Month
Day
Year
Emergency Information
Primary Parental Contact
A copy of this form will be sent to the email address listed for this contact.
Primary Parental Contact Name*
Email*
Home Phone
(###)###-####
Cell Phone
(###)###-####
Work Phone
(###)###-####
Secondary Parental Contact
Secondary Parental Contact Name*
Secondary Parent Email
Secondary Parent Home Phone
(###)###-####
Secondary Parent Cell Phone
(###)###-####
Secondary Parent Work Phone
(###)###-####
Please list emergency contacts (other than parents):
Emergency Contact 1 Name*
Contact 1 Relationship to camper
Contact 1 Phone
(###)###-####
Emergency Contact 2 Name*
Contact 2 Relationship to camper
Contact 2 Phone
(###)###-####
Medications & Health
Please list any medications or special health situations we should be aware of during camp sessions:
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Select Week(s)
Please select the week(s) you would like to attend.
Prices are as follows: 3 weeks ($460), 2 weeks ($335) or 1 week ($210). All full day camp registrations include lunch catered by Sage Dining Services.
- 1st week (June 2-6)
- 2nd week (June 9-13)
- 3rd week (June 16-20)
One shirt is included with each Jumpin’ for Joy Registration. Shirts are distributed on the first day of camp. Additional shirts may be purchased for $15 each.
Youth Small Qty.
Youth Medium Qty.
Youth Large Qty.
Adult Small Qty.
Comments
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Jumpin' for Joy - Waitlist Registration Form

Camper Information

Emergency Information

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