Club J Registration « Robert E-Loup JCC Denver

Child's Name*

First
Last
Child's Date of Birth*
Name of Child's School*
Parent/Caregiver Name*

First
Last
Parent/Caregiver Phone*
Parent/Caregiver Cell Phone
Parent/Care Giver Email*

Enter Email
Confirm Email
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
2nd Parent/Caregiver Name

First
Last
2nd Parent/Caregiver Cell Phone
2nd Parent/Caregiver Cell Phone
2nd Parent/Care Giver Email

Enter Email
Confirm Email
Persons Authorized to Pick up the Child

Please list all names and phone numbers of all persons authorized to pick up the child.

Food Restrictions
Describe Your Food Restrictions
Do You Keep Kosher?*
I have already filled out all Medical Forms & Legal Release Forms for Club J or other JCC K-6th Grade Programs?*

Club J REQUIRES Medical Forms to be filled out in full prior to your child’s first day.
Please download and complete the medical form and return to Club J by:

Dropping it off at the JCC

Faxing it to (303) 320-0042

Or mailing it to

JCC Denver

ATTN: CLUB J

350 S. Dahlia St.

Denver, CO 80246

Download Medical Form

Download Legal Release Form
Sunscreen
- I give permission for JCC Staff to provide and apply sunscreen for my child
According to Colorado Rules and Regulations and our child care license, we must have written permission in order for us to apply sunscreen to your child at Club J. Please mark the sunscreen bottle with your child’s last name. Additionally, Club J staff will have extra sunscreen in the event that your child does not have sunscreen with him/ her. Please let us know if your child is allergic to a certain brand of sunscreen. By checking the above box you give permission for Club J staff to apply sunscreen to your child while at Club J. Additionally, in the event that your child does not have sunscreen with him / her at Club J, you give permission for a Club J staff member to apply Target brand or Coppertone 50 camp sunscreen to your child.

Parental Consent

I understand there are inherent risks in a variety of activities in which my child will participate during JCC programs. By signing this waiver, I state that my child is in proper physical, mental and emotional conditions to participate in all of the activities of Club J including field trips. I give permission for my child to be transported by a private bus company or a JCC employee driving the JCC bus or van, or Denver Public School District bus transportation. I waive any right to any and all claims that I may have against the staff and representatives for any injuries or accidents my child may suffer as a result of his/her participation therein. I understand that in the event of an emergency and I cannot be reached, permission is hereby granted to JCC personnel to secure medical treatment for my child. I give my permission for any emergency physician to treat my child registering for Club J.” I accept responsibly for all medical expenses incurred.

By entering your name and today’s date below, you are agreeing to the above Parental Agreement.
Parent Name*

First
Last
Today's Date*

Club J Registration