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System Maintenance

Inquiry Form

Notice: Required fields have a dotted underline.
Notice: Required fields are marked with a red asterisk at the end.
About You (Parent/Guardian)
First Name
Last Name
Relationship
Email
Phone
Ex: 303-555-5555
 

How would you prefer to be contacted?

( Best time to call   )
Add another parent/guardian from your household.

Add another parent/guardian from your household.

Second Parent/Guardian
First Name
Last Name
Relationship
Email
Phone
Ex: 303-555-5555
 

Hide Second Parent/Guardian

Add a parent/guardian who resides at another address.

Add a parent/guardian who resides at another address.

Do not add Household #2

Household #2

Household #2, Parent #1
First Name
Last Name
Relationship
Email
Phone
Ex: 303-555-5555
 
Add another parent or guardian to this household.

Add another parent/guardian to this household.

Household #2, Parent #2
First Name
Last Name
Relationship
Email
Phone
Ex: 303-555-5555
 

Do not add Second Parent/Guardian

Add another child

Additional comments Additional comments 

Children's privacy is of primary concern to us, and our Policy and practices reflect applicable laws and regulations on children's privacy. We do not knowingly collect personal information from children under 18 years of age. Any communication we get that is identified as being from a child under 18 will be immediately removed from our database. All information gathered from our camp families is used exclusively for camp, and no third-party vendors. We urge parents to regularly monitor and supervise their children's on-line activities.

Thank You

Your Inquiry Form was submitted successfully.
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Yachad / NJCD is dedicated to enhancing the life opportunities of individuals with disabilities, ensuring their participation in the full spectrum of Jewish life. Yachad members participate in activities each month. There are Yachad Chapters located throughout the United States, Canada and Israel.