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Language+Math Study Summer Camp
Enrollment is taken on a first-come, first-served basis
. There is limited enrollment per camping session so we urge that registration be made early and for the exact number of camping periods desired.
Indicates required field
Date of Birth ( Month/Day/Year)
Grade in September:
Choose the language you are interested
Name of the school you are attending
Parent/Guardian's Phone Number
Emergency Contact Name
Emergency Contact Phone Number
Other questions or comments (Optional)
Camp Session ( Two weeks each session)
Session 1 ( July 1st - July 12)
Session 2 (July 15 - July 26 )
Session 3 ( July 29 - August 9th)
Session 4 ( August 5th - August 16th )
Session 5 (August 19 - August 30th)
Group A (Ages 6-8)
Group B (Ages 9 - 12)
Group C (Ages 13 - 15)
Camp Bus Pick-up/Drop-off:
M, W, F
Please Select Camp Dates
M - F
M, W, F
Morning (7:00am - camp start)
Afternoon (Camp end - 5:00pm)
Please Select Camp T-Shirt Size
Payment can be made (After you received invoice from our Admission Office)
- by Check payable to JPLI - Summer Camp,mail it to: JP Language Institute, 200 Broadhollow Road,Suite 207, Melville, NY 11747
- Or Visa,Master card via paypal at:email@example.com
Please read the enrollment terms before submitting the registration form.
1. I understand that a nonrefundable and one time $145 registration fee must accompany each camper's registration form. A billing statement will be sent to all enrolled campers participants. Full payment for all programs is due June 15, 2019. These payments are non-refundable, regardless of the reason for withdrawal.
All checks should be made payable to 2019 Summer Language Camp - JPLI. The face of all checks should
clearly list the name of the camper.
2. I understand that there are no refunds and no make-up days of camp or workshops for time missed.
3. I understand that for campers enrolling after May 30, 2019 full payment, plus the $145 registration fee, is due at the time of registration.
4. I understand
A non-refundable/non-transferable deposit of $145 is required for each session for each student. The remaining balance must be paid in full 3 weeks prior to the start of the camp session or your student will not be permitted to begin camp. There will be a $25 fee for late payment.
5. I understand that children shall abide by all the rules and regulations of JP Language Institute 2019 Summer Language Camp. JPLI reserves the right to dismiss any boy or girl from the program at its discretion. In such cases, a prorated refund will be given for time lost.
6. I understand that a medical form will be sent to me upon receipt of this registration form, and I understand that the medical form must be completed by the parents immediately and be on file before the camper may begin camp.
7. All Summer program participants may be checked for Pediculosis (head lice). Any child found to have Pediculosis will be excluded from the program until the hair is free from all nits and lice as determined by the camp nurse. No refund is made for the time lost due to Pediculosis.
8. I give permission for JPLI to have my child examined at a hospital emergency room in the event that a parent or the family physician cannot be contacted in an emergency.
9. I understand that the JPLI 2019 Summer Language Camp assumes no responsibility for any minor injuries that could occur during the camp day or for the aggravation of pre-existing medical conditions.
10. I understand that the JPLI 2019 Summer Language Camp assumes no responsibility for lost or stolen property, and actively discourages campers from bringing anything of value to camp. No radios, other electronic equipment or glass containers are permitted.
11. I give permission for the JPLI 2019 Summer Language Camp to take photographs and videos of my child, and agree that the camp has the right to use these materials in future brochures, newspaper or promotional advertisements.
12. I understand that the JPLI 2019 Summer Language Camp accepts campers on a first come, first served basis beginning in May 15, 2019, and that enrollment is limited in all programs. JPLI 2019 Summer Language Camp does not discriminate on the basis of gender, race, or creed. All children are admitted equally to all programs.
13. I understand that children who are not enrolled in the JPLI 2019 Summer Language Camp are not permitted to attend a portion of the programs as guests of the enrolled participants.
14. I understand that all cancellations or changes in registration must be in writing.
200 Broadhollow Road, Suite 207,
Melville, NY 11747
200 Broadhollow Road, Suite 207,
Melville, NY 11747
- 2 West Main Street, Bay Shore,NY 11706
1225 Franklin Avenue, Garden City, NY 11530
-71 West 23rd Street, Suite 515, New York,
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