2025 Summer Registration Form

All information must be completed for each registered child. 50% payment must be submitted with the application or space will not be reserved. Payment can be made with a check payable to the Town of Jericho or a CREDIT CARD. Checks should be mailed to Town of Jericho Attn: Lynn Wagner, PO Box 39, Jericho, VT 05465).

The remaining 50% balance will be due on or before Monday June 2, 2025 for ALL sessions. NO REFUNDS WILL BE GIVEN AFTER MONDAY JUNE 2, 2025.

Lynn Wagner's email: lwagner@jerichovt.gov

NEW for 2025- registration fees include all field trips!

To qualify for registration as a "Jericho resident," a family must be a Jericho property tax payer.

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Child's First and Last Name:

* required

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Age:

* required

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Date of Birth:

* required

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Grade completed by 6/20/25 (please state preschool year 1 or year 2 only for pre k campers)

* required

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Parent/Guardian:

* required

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Relationship:

* required

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Primary Number: please no spaces

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Secondary Number: please no spaces

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Email:

* required

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Mailing Address: include Town/City and State

* required

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Parent/Guardian:

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12.

Relationship:

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13.

Primary Number: please no spaces

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14.

15.

Does your child have permission to sign themselves out of the Summer Rec Camp at the end of the day at 3:30 p.m.?

* required

Yes they can

No they can not

16.

Jericho Resident $670.00

Non-Resident $745.00

Jericho resident is defined as a family that pays Jericho property tax

17.

Register camper for 3 weeks (pick any three weeks-does not have to be consecutive) select the 3 weeks from list below. Registration now includes all field trip fees!

Jericho Resident $355.00

Non-Resident $405.00

Week 1: June 23 -27

week 2: June 30- July 3

week 3: July 7- 11

week 4: July 14- 18

week 5: July 21- 25

week 6: July 28- August 1

Jericho resident is defined as a family that pays Jericho property tax

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Week 1 Jericho Resident $165.00

Week 1 Non Resident $180.00

Week 2 Jericho Resident $165.00

Week 2 Non Resident $180.00

Week 3 Jericho Resident $165.00

Week 3 Non Resident $180.00

Week 4 Jericho Resident $165.00

Week 4 Non-Jericho Resident $180.00

Week 5 Jericho Resident $165.00

Week 5 Non Resident $180.00

Week 6 Jericho Resident $165.00

Week 6 Non Resident $180.00

Jericho resident is defined as a family that pays Jericho property tax

19.

Parental Permission for Child Pick up (Don't forget to include yourself)

* required

Please list the names of anyone who has permission to pick up your child from the Recreation Program. If names need to be added or deleted please email Lynn Wagner (lwagner@jerichovt.gov)

20.

Medical Form

* required

Please fill out the Medical Form, save the form after it's filled out then attach the saved file here

21.

Field Trip Permission Form (parents will be notified of field trips in weekly newsletter

* required

Yes I give permission for my child to go on all scheduled Field Trips

No I do not give permission for my child to go on scheduled Field Trips

22.

Emergency Contact other than parent or guardian

* required

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23.

Phone Number of Emergency Contact Person: please no spaces

* required

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24.

I give permission to use my child's photo in any Town related documents/brochures or to the Town of Jericho's social media pages

* required

Yes

25.

I have read all the Policies below -These policies are under Document Library scroll down to Summer Recreation

* required

Anti-Bullying/Harassment Policy

Discipline Policy

Town of Jericho Abuse Prevention Poicy

Health Care Policy