JAM Registration Form
415.425.0372 * charity@jamjamjam.com * www.jamboodas.com * www.jamjamjam.com
Class and Camp Information
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I am registering for a...
Spring JAMboodas Class
Summer JAMcamp
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Please choose your class day and time:
JAMboodas Friday 9:30am
JAMboodas Friday 10:30am
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Please choose your JAMcamp dates:
SUMMER: Week of June 11-15
SUMMER: Week of June 18-22
SUMMER: Week of July 9-13
SUMMER: Week of August 13-17
SUMMER: Week of August 20-24
Student Information
Child #1:
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First Name
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Last Name
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Birth Date
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Age
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Grade (for 2012-2013 school year):
No grade! I'm to little for school ;-)
Pre-school
Pre-K
K
1st
2nd
3rd
4th
5th
Name of school, if applicable:
Child #2:
First Name
Last Name
Birth Date
Age
Grade (for 2012-2013 school year):
No grade! I'm to little for school ;-)
Pre-school
Pre-K
K
1st
2nd
3rd
4th
5th
Name of school, if applicable:
Parent/Guardian/Emergency Contact Information
Parent/Guardian #1:
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First Name
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Last Name
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Relationship to child(ren)
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Main Phone (xxx-xxx-xxxx)
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Alternate Phone (xxx-xxx-xxxx)
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Email Address
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Address
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City
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State
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Zip
Parent/Guardian #2:
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First Name
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Last Name
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Relationship to child(ren)
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Main Phone (xxx-xxx-xxxx)
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Alternate Phone (xxx-xxx-xxxx)
Email Address
Address (if different from above)
City
State
Zip
Please provide one ADDITIONAL emergency contact:
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First Name
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Last Name
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Relationship to child(ren)
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Main Phone (xxx-xxx-xxxx)
Alternate Phone (xxx-xxx-xxxx)
Lastly...
Any allergies or medications we should be aware of?
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How did you hear about us?
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