Child’s Name(s)

Age(s)

Parent Name(s)

Street Address

City

State

ZIP

Home Phone

Work #

cell

School your Child Attends:

Insurance Provider

Primary Care Doctor

Ph#

E-mail:

Please check the dates of the camp(s) you’d like to register for:

Week 1—June 12 ($150)

Week 2—June 19

Week 3—June 26

Week 4—July 10

Week 5—July 17

Week 6—July24

Week 7—July 31

Week 8—August 7

Please select Payment Method:

 Check/Cash

(Please print this form and mail with payment)

Pay by phone with Credit Card

(Please do not provide credit card info at this time. We will contact you regarding payment.)

Or: Print and Mail with Payment to:

JUMP! Fun Camps for Kids

7620 N. Hartman Ln #114

Tucson, Arizona  85743

Call 579-6736  or   579-6781

for more information!