2024-2025 JDays Registration Form

Participant Information

Only ONE child per form

Legal First Name

Legal Last Name

Name Participant Wishes To Be Called

Participant Program (K-Grade 8 only)

JDays 5 Days

Date of Birth

Age

Gender

Grade (K-Grade 8 only)

School

If you chose Other, please provide School Name:

Our staff will walk over students from Ben Gamla Kendall and Somerset Prep, and we provide bus transportation from Leewood K-8 Center and William Lehman Elementary. My child will NOT be picked up by JCC staff and will instead be dropped off at the JCC using our own private transportation.

Yes No

Address

Address2

City

State

Zip

Medical Concerns & Allergies

Physician's Name

Physician's Phone Number