Registration Form - Camp Jambalaya Waitlist "*" indicates required fields 1Camper2Guardian3Accommodations 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?* No 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.EmailThis field is for validation purposes and should be left unchanged. Δ
