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2017-2018 JCCNS School Year Registration
Fill out this form to register your child(ren) for the JCCNS school year.
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Parent/Guardian Information
Parent/Guardian Name *
Primary Phone Number *
Parent/Guardian Name
Phone Number
Secondary Phone Number(s)
Address of Residence   *
Email Address   *
Student Information
Child's name *
Child's Date of Birth *
List and describe any allergies that affect your child. *
Does your child have any health or developmental issues we should be aware of? *
What is your child's reaction to new situations/people? *
Has your child had previous preschool or daycare experience? *
Is your child potty-trained? *
Emergency Contact & Authorized Persons
Emergency Contact   *
Emergency Contact's Phone Number(s) *
Please provide a list of any individuals not listed above who may pick your child up from school
Student Registration Information
Registration Type *
Please Check the box(es) of the Morning Sessions for which you would like to enroll your child.
Please Check the box(es) of the Afternoon Sessions for which you would like to enroll your child.
By typing my name in the space provided, I understand that I agree to the terms and conditions laid out in the JCCNS Parent Contract.  (See: https://docs.google.com/document/d/1GUmsn-KwFI3NyFXpyla_HTvhHjtj0FVwF_ag1jBUu2E/edit?usp=sharing) *
You've reached the end of the form. One of our teachers, Dara Lavallee or Kristen Stager, will be in touch shortly to confirm your registration. Your child's space is not reserved until we receive your registration fee ($0 for Brit Shalom Members, $40 before April 1st, $60 April 1st and after). Please mail a check made out to JCCNS of State College to 620 E. Hamilton Ave. State College, PA 16801
The Jewish Community Center Nursery School of State College, Inc.  admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school.
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