JA BizTown Summer Camp Registration 2017
RequiredRequired Question(s)
Dear Parents,
Students enrolling in this camp must attend Pittston Area School District and be entering 5th or 6th grade in the fall of 2017.  Camp will be held June 26, 2017 - June 30, 2017 from 9:00 AM-3:30 PM and is sponsored by Mericle Commercial Real Estate Services.  There is no fee to attend camp, and one snack and lunch daily are included in the camp.  A menu will be provided prior to the start of camp, however, campers may choose to pack a lunch if they prefer.
All questions marked with an * are required to be answered.  A JA BizTown staff member will contact you once your application has been submitted.  If you have any questions, please call the Junior Achievement office at 570-602-3600.
 
Required 1.
What is the camper's first and last name?
 

350 characters left.
Required 2.

What is the camper's gender?


Male
Female
Required 3.

What is the camper's age?  (Camp is open only to students entering fifth or sixth grade in the fall of 2017).

 

50 characters left.
Required 4.

Please select the grade the camper will enter in the fall of 2017.

Fifth Grade
Sixth Grade
Required 5.

Has your camper attended JA BizTown with his or her school?  Please note, previous experience is not required for summer camp attendance.  

Yes
No
Required 6.

Please enter the Mother or Guardian's First and Last Name:

 

50 characters left.
Required 7.

Please enter the Mother/Guardian's daytime phone number.

 

50 characters left.
Required 8.

Please enter Mother/Guardian's email address.

 

50 characters left.
Required 9.

Please enter the Father or Guardian's First and Last Name.

 

50 characters left.
Required 10.

Please enter the Father/Guardian's daytime phone number.

 

50 characters left.
Required 11.

Please enter the Father/Guardian's email address.

 

50 characters left.
Required 12.
Please enter the information indicated below for the Parent and/or Legal Guardian of the Camper.

Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 13.

Is the Camper's address the same as the parent/guardian address indicated in Question 12?

Yes
No
14.

If you answered "No" to Question 13, please enter the Camper's home address below.

 

350 characters left.
Required 15.

Junior Achievement of Northeastern Pennsylvania, Inc. follows a strict pick-up policy.  Be sure to include all individuals to whom your child may be released at pick-up time.  Your child will not be released to any person whose name does not appear on this list.  A photo ID is required by anyone picking up your child.  NO EXCEPTIONS to this policy will be granted.  

Below, please provide the name and telephone number of up to 3 people permitted to pick up your child from camp.

 

1000 characters left.
Required 16.

In the event of an emergency, JA BizTown staff will first contact the parent or legal guardian of the Camper.  If the parent/legal guardian cannot be reached, please provide the names and telephone numbers of at least two individuals that may be contacted in an emergency.

 

1000 characters left.