Applicant's Information Which program are you applying for? * Summer 2019, Girls Program (Jul 22 to Aug 7, 2019) Applicant's First Name * Applicant's Last Name * Applicant's Contact Email * Applicant's Contact Phone * Home Street Address * City * State * Zip * How far is your house from the nearest public transportation (bus or subway)? * 0.5 miles or less 0.6 miles to 1 mile >1 mile Has your family participated in our program in the past? * Yes No In which year(s) did your family participate? Basic Family Information Mother's/Parent 1's Name * Mother's/Parent 1's Mobile Phone * Father's/Parent 2's Name * Father's/Parent 2's Mobile Phone * Home Phone Number Please list your pets * Children's name(s), gender and date of birth * Family Interests (Activities, Hobbies, etc.) * Other Family Information Alternate person to notify in case of emergency Alternate Person to Contact's Phone Number Why does your family want to participate in our program? Family References How did you hear about our program? * Internet Search School/Teacher Parenting Resource (Mom's and Dad's Guide, BostonParent, Baystateparent, etc.) Social Media (Facebook, Twitter, Instagram, etc.) Camp Fair Newspaper Newsletter Referral If referred by someone, who? (Referred By) Please name a reference, with contact information, who can recommend your family’s participation in our program. THE NEXT SECTION IS ONLY FOR THOSE APPLYING FOR THE SUMMER PROGRAM FOR GIRLS AND BOYS IN MILTON, MA.Once you are finished, click the SUBMIT button to submit your family's application into our system. Is an adult available to drive your visitor and child participating in EJP to and from campus each day? Yes No Participant Information Child Participant's Name Age Gender Date of Birth All participants receive an Explore Japan T-shirt. What size should we order? Youth Small (6-8), 22x17 Youth Medium (10-12), 23.5x18 Youth Large (14-16), 25x19 Youth XL (18-20), 26.5x20 Adult Small, 28x18 Adult Medium, 29x20 Adult Large, 30x22 Adult XL, 31x24 Adult 2XL, 32x26 Note: Garment measurements are in inches (LxW). Length is shoulder seam at collar to bottom hem. Width is armhole to armhole across chest. Do you have any other child(ren) who are interested in participating in Summer EJP Programs? Yes No Please list name(s) of additional child participating and indicate their shirt size Family Physician Physician's Phone Number Is the student receiving medication or any continuing medical supervision? Is she or he allergic to insect bites or specific medication? Please describe any physical concerns for your child, including food allergies If student is taking medication with him/her during this program, please list the name, amount to be taken, and time of day for each medication Name of insurance and Policy/Subscriber Number
