Summer Camp Application 2020 Online Application -Summer Camp School of Choice*Baby World - 485 Ocean Avenue, Jersey CityJersey City Daycare 100 - 409 Halladay Street, Jersey CityParkside Preschool 1 - 202-206 Central Avenue, Jersey CityParkside Preschool 2 - 354 Park Avenue, Jersey CityParkside Preschool 3 - 567 Broadway, NewarkWhich summer session do you need?*Full Day SessionHalf Day SessionFull Day - 8AM to 5PM Half Day- 8AM to 12PMChild's Name* First Last Suffix Full name as listed on the birth certificateChild's Date of Birth* MM DD YYYY Gender* Male Female Language(s) Spoken at HomeHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Doctor's Information* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Doctor's Phone #*Are you eligible for Urban League or any other subsidy assistance? Yes No Unsure, Please send additional information Parent/Guardian #1 InformationName* First Last Relationship to Child* Mother Father Legal Guardian Daytime Phone*Mobile PhoneEmail* Parent/Guardian #2 InformationName First Last Relationship to Child Mother Father Legal Guardian Daytime PhoneMobile PhoneEmail Parent Certification* I agree to the privacy policy.I certify that the statements made by me in this application are true, complete and correct to the best of my knowledge.Name* First Last CAPTCHA