Step 1: Parent Information
Parent 1
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Employer:
*
Cell Phone:
*
Alternate Phone:
*
Email:
*
(this will be used for registration confirmation)
Parent 2
First Name:
Last Name:
Check this box to copy address from above.
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Employer:
Cell Phone:
Alternate Phone:
Email:
Step 2: Child's Information
Child's Full Name:
*
Nickname:
Date of Birth:
*
Gender:
*
Child lives with:
Both Parents
Parent 1
Parent 2
Grand Parents
Parent 1/Step-Parent
Parent 2/Step-Parent
Other Guardian
Any known special needs:
*
Allergies:
*
Any other health concerns:
*
Please describe your child's personality and anything you think would be helpful for your teacher to know:
*
Select Class: I would like to register my child for: (please select one)
CLASS
HOURS
DAYS
MONTHLY TUITION
Kindergarten
8:30am - 2:30pm
M-F
$560
Pre-Kindergarten
8:30am - 2:30pm
M-F
$460
3 Year-Old Class
8:30am - 2:30pm
M-F
$455
2 Year-Old Class
8:30am - 12:00pm
M-F
$390
12-24 Month Class
8:30am - 12:00pm
M-F
$400
Before and After School Options (paid monthly)
None
Early Einsteins (paid monthly)
All grades:
7:00 – 8:30 am
$105
All grades:
7:30 – 8:30 am
$80
Afternoon Adventurers (paid monthly)
3-year-olds to Kindergarten:
2:30 - 6:00 pm
$245
12 months to 2-year-olds:
12:00 - 2:30 pm
$200
12 months to 2-year-olds:
12:00 - 6:00 pm
$360
All-Day Learn and Play (paid monthly)
12 months to 2-year-olds:
7:00 - 8:30 am & 12 - 6:00 pm
$395
3-year-olds to Kindergarten:
7:00 - 8:30 am & 2:30 - 6:00 pm
$300
Additonal Child - Yes?
2nd Child's Information
Child's Full Name:
*
Nickname:
Date of Birth:
*
Gender:
*
Child lives with:
Both Parents
Parent 1
Parent 2
Grand Parents
Parent 1/Step-Parent
Parent 2/Step-Parent
Other Guardian
Any known special needs:
*
Allergies:
*
Any other health concerns:
*
Please describe your child's personality and anything you think would be helpful for your teacher to know:
*
Select Class: I would like to register my child for: (please select one)
CLASS
HOURS
DAYS
MONTHLY TUITION
Kindergarten
8:30am - 2:30pm
M-F
$550
Pre-Kindergarten
8:30am - 2:30pm
M-F
$450
3 Year-Old Class
8:30am - 2:30pm
M-F
$450
2 Year-Old Class
8:30am - 12:00pm
M-F
$380
2 Year-Old Class
8:30am - 12:00pm
M-W-F
$275
12-24 Month Class
8:30am - 12:00pm
M-F
$380
Before and After School Options (paid monthly)
None
Early Einsteins (paid monthly)
All grades:
7:00 – 8:30 am
$105
All grades:
7:30 – 8:30 am
$80
Afternoon Adventurers (paid monthly)
3-year-olds to Kindergarten:
2:30 - 6:00 pm
$245
12 months to 2-year-olds:
12:00 - 2:30 pm
$200
12 months to 2-year-olds:
12:00 - 6:00 pm
$360
All-Day Learn and Play (paid monthly)
12 months to 2-year-olds:
7:00 - 8:30 am & 12 - 6:00 pm
$395
3-year-olds to Kindergarten:
7:00 - 8:30 am & 2:30 - 6:00 pm
$300
Other children in family
Name:
Age:
School:
Name:
Age:
School:
Name:
Age:
School:
Are any other languages spoken at home?
*
Do you identify with a Jewish denomination (i.e. Reform, Conservative, Orthodox)? If so, which?
*
If you are new to The J, please let us know how you found out about us:
*
Authorized Pick-up Information:
Name:
*
Relationship:
*
Cell Phone:
*
Name:
Relationship:
Cell Phone:
Name:
Relationship:
Cell Phone:
Medical & Other Information:
Child(ren)'s pediatrician: (name, address, phone number)
*
Child(ren)'s dentist: (name, address, phone number)
*
In case of emergency, transport my child to:
Hospital:
*
Hospital address:
*
Hospital phone:
*
In case of an emergency in which the parents cannot be reached, please call:
Name:
*
Relationship:
*
Phone number:
*
Comments, or are there any special issues in your child/ren's history of which we should be aware
(social, emotional, medical, physical, etc)?
Signature:
By submitting this enrollment application, I hereby agree to comply with the policies and procedures of The J Center for Early Learning specified in the Parent Handbook and any other policy statements issued by the school during the year. My signature verifies that all information provided is true and accurate:
Parent Signature - (please type your name as your signature):
*
Date:
*
Consent:
My Child(ren) has/have my permission to participate in all school sponsored activities and excursions. This includes field trips by bus, car or class walks to nearby points of interest. I will be notified in advance of any off-campus trip, and may be provided with additional permission slips relating to such trips.
I understand that all reasonable measures will be taken to safeguard the health and well-being of the children while at The J Center for Early Learning. The J Center for Early Learning will notify me as soon as possible in the event of an emergency or other reportable matter. However, in the event of an accident I will not hold the school or drivers legally responsible.
In case of sickness or accident, on or off the school grounds, I authorize The J Center for Early Learning or its designee to contact physician(s), medical providers, first responders and others to provide medical or emergency services to care for my child(ren) at my expense. This includes treatment in a hospital emergency room, if such treatment is deemed necessary for the health and well-being of my child.
Additional documentation may be provided at a later date to further the general permission granted in this paragraph.
As parents (guardians), we agree to relieve The J Center for Early Learning of any liability for accident or injury occurring on school premises or on field trips:
Parent 1 Signature - (please type your name as your signature):
*
Date:
*
Parent 2 Signature - (please type your name as your signature):
Date:
Pictures of my child taken by The J Center for Early Learning may appear in in-house publications (such as newsletters, Facebook, etc.); as publicity for the school; and in our student directory unless I opt out below:
Do not publish photos of my child online.
Do not publish photos of my child in print.