Summer Programs

Download Summer Form

Application Form for Summer Program

PeaceNJoy Academy, A business of PeaceNJoy Academy Inc.
1075 Easton Ave, Somerset, NJ-08873

Child's Information

Credentials of the child

Child's Name*
First Name
Last Name
 
Child's Date of Birth*
Child's Gender*

Father's Information

Credentials of the child's father.


Mother's Information

Credentials of the child's mother.


Authorized Person(s) for Child Relations

Person(s) authorized to pick up the child in case parents are not available.

First Authorized Person


Second Authorized Person


Child's Medical Information

Please include the child's full medical history.

  • I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of a medical emergency.
    I release PeaceNJoy Academy and its Management and Staff from liability in case of accident during activities related to PeaceNJoy Academy, as long as normal safety procedures have been taken.
    I accept that tuition is based on the school year and there is no credit for any absence. There are no refunds, tuition adjustment, or make up days when my child is absent due to weather, holidays, illness, or family vacation. Full payment is required to maintain a place for my child on the school register.
Date of Application Submission *
Primary Email Address*
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