Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Enrollment *

New

Returning

Sibling in program

Sibling in Program

First Name

Last Name

Registration *

Select the number of weeks you'd like to enroll in.

4 weeks | $1995

5 weeks | $2495

6 weeks | $2995

7 weeks | $3495

Dates *

Select the specific dates for the number of weeks chosen above. (*JCC is closed July 4)

Week 1: 6/30 - 7/4*

Week 2: 7/7 - 7/11

Week 3: 7/14 - 7/18

Week 4: 7/21 - 7/25

Week 5: 7/28 - 8/1

Week 6: 8/4 - 8/8

Week 7: 8/11 - 8/15

Extended Care Options

Price per week.

Before Care | $75

After Care | $125

Financial Agreement *

I agree to pay the non-refundable registration fee of $200 at the time of registration and the non-refundable facility fee of $99 and any program fee selected above by May 23, 2025. As explained in the Summer at the J Parent's Guide, I understand that I will be charged if I am late to pick up my child. (After 4:30pm: $35/day for Extended Care and after 6:00pm: $5/minute until your child is picked up.)

I agree

Policy Confirmation *

I confirm I have read, understood, and accepted the terms, policies and procedures outlined in the Summer at the J Parent's Guide.

I confirm

Photo & Video Permission *

I allow photographs and video of my child to be used for future publicity including (but not limited to) our website, our social media channels, program brochures and printed materials.

I do not allow photographs and video of my child to be used for any purpose.

Parent/Guardian 1 *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Parent/Guardian 2

First Name

Last Name

Parent/Guardian 2 Address

Only if different from Parent/Guardian 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian 2 Phone

(###)

###

####

Emergency Contact 1 *

First Name

Last Name

Emergency Contact 1 Phone *

(###)

###

####

Emergency Contact 2 *

First Name

Last Name

Emergency Contact 2 Phone *

(###)

###

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