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All Day @ The JCC Virtual School Program
Please complete the form below to enroll each child in the All Day @ The JCC Virtual School Program.  If you have any questions, please contact Kim Vukov, Director of Youth Services, at 516-484-1545, kvukov@sjjcc.org.
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Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Current Grade (as of September 2020) *
Current School (as of September 2020) *
Allergies
Gender *
Address *
City *
Zip Code *
Home Phone *
Name of Parent/Guardian #1 *
Parent/Guardian #1 Email Address *
Parent/Guardian #1 Cell Phone *
Parent/Guardian #1 Work Phone *
Name of Parent/Guardian #2 *
Parent/Guardian #2 Email Address *
Parent/Guardian #2 Cell Phone *
Parent/Guardian #2 Work Phone *
The following people have permission to pick-up my child.  Please list name, relationship and phone number.
Does your child have any underlying medical conditions we should be aware of? Please supply us with a copy of their medical information. *
Does your child have any special needs that we should be made aware of? Please supply us with a copy of their IEP and/or any otherinformation that may help us help your child adjust to the program. Please note: all information is confidential. *
Please select the schedule that you would like to enroll the child above for. *
8:00am-2:00pm
8:00am-4:00pm
Three Days Per Week
Five Days Per Week
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