Camp Registration 2023

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

Parent #1 Cell Number

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Number

* Street

* City

* State

* Zip

* Child's Full Name

* Gender

* Date of Birth

* Do you need early drop-off?

* Program (Deposit $500 due today, Balance due by May 15, 2023)

* I would like WJC to charge the balance using my credit card on May 15, 2023

YESNO - I will pay my balance with a different payment method by May 15, 2023

Total Deposit

Sat, April 1 2023 10 Nisan 5783