Home • Camp Jambalaya Jubilee • Register Register for Camp Jambalaya Jubilee Registration ends May 3rd Got Questions? Email us at childrenandarthritis@gmail.com "*" indicates required fields 1Camper2Guardian3Accommodations4Payment Child's Name* First Last Date of Birth* Month Day Year Diagnosis*Child’s Age in June at Jambalaya Jubilee*123456789101112131415161718Have you been to camp before? Yes How many times have you been to Camp Jambalaya (Not including this registration)T-shirt Size*Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeDoes the child have siblings who will attend camp?*NoYes2nd Child's Name First Last Date of Birth Month Day Year 2nd Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAny more Siblings?NoYes3rd Child's Name First Last Date of Birth Month Day Year 3rd Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large4th Child's Name First Last Date of Birth Month Day Year 4th Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large5th Child's Name First Last Date of Birth Month Day Year 5th Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large6th Child's Name First Last Date of Birth Month Day Year 6th Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large7th Child's Name First Last Date of Birth Month Day Year 7th Child’s Age in June at Jambalaya Jubilee12345679101112131415161718T-shirt SizeYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large Will your mother be attending camp?* Yes No Mother's Name* First Last Mother's Phone*Mother's Adult T-shirt Size*Adult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult XXXLWill your father be attending camp?* Yes No Father's Name* First Last Father's Phone*Father's Adult T-Shirt Size*Adult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult XXXLParent Contact Info* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Need for Handicap Accessibility?* No Yes If yes, handicap accessibility for whom?*Child with ArthritisParent or GuardianSibling 1Sibling 2Sibling 3Sibling 4Sibling 5Any Allergies in Children?Any Allergies in Adults?Number of Dorm Rooms Needed*OneTwoThreeFour* Each room has 2 twin beds. Please make a conscious effort to be economical with your selection – we typically assign 1 bed per person, but allow those with babies and young children to choose if they would like less rooms. Centenary College Dorms are set-up where 2 rooms connect to a shared bathroom. If a 3rd room is selected, that room will not be connected to the others. Each family will have their own room(s) and bathroom. Please specify any other special accommodations needed at camp. Registration Fees: EARLY BIRD RATES $20/adult and $10/child. After May 15, ratesare $50/child and $100/adult. Fees include rooms, meals, and all of your activities. Please note there is a $1.50 charge to help cover our online payment fees. Also, remain mindful that the actual cost of attendance without grant funding is over $300 a person. It’s important, therefore, to only register those who qualify for this funding: your child with arthritis, their immediate siblings, and 2 parents/guardians. If we discover that friends of your children are in attendance, you will be charged a $300 fee to cover their expense. If you would like to support Children and Arthritis additionally, simply click on “Donate Here” on our home page after you register. Your donation will be 100% tax-deductible and you will be listed in our sponsor acknowledgements. Total number of children attending camp Quantity* Price: $10.00 Quantity Total number of parents/guardians attending camp (limit 2) Quantity* Price: $20.00 Quantity Total Credit Card*Card Details Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country *Late Registration Notice: Late registration is subject to additional fees and penalties. These registrations will be discussed on a case-by-case basis and can be denied in the event of limited space or time constraints. Please make every effort to register during our registration period so that we can prepare adequately for Jambalaya Jubilee. Registration Refund: Jambalaya Jubilee cancellations must be received in writing by May 31 at 5 PM for a full refund. If a cancellation is received after that date, the registration fee will be considered a donation to Children And Arthritis, Inc. You will receive tax benefits for this donation to the full extent of the law. Don’t Forget To Bring: Twin bedding for each person, towels, toiletries, bathing suits, tennis shoes, and snacks/food if you have special dietary needs. We look forward to seeing you! Questions/Concerns? Contact our Executive Director, Sheri Rowell Email: ChildrenAndArthritis@Gmail.Com Phone: (318) 200-0667 PhoneThis field is for validation purposes and should be left unchanged. 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