2017-2018 JCCNS School Year Registration
Fill out this form to register your child(ren) for the JCCNS school year.
Parent/Guardian Information
Parent/Guardian Name
Your answer
Primary Phone Number
Your answer
Parent/Guardian Name
Your answer
Phone Number
Your answer
Secondary Phone Number(s)
Your answer
Address of Residence
Your answer
Email Address
Your answer
Student Information
Child's name
Your answer
Child's Date of Birth
Your answer
List and describe any allergies that affect your child.
Your answer
Does your child have any health or developmental issues we should be aware of?
Your answer
What is your child's reaction to new situations/people?
Your answer
Has your child had previous preschool or daycare experience?
Is your child potty-trained?
Emergency Contact & Authorized Persons
Emergency Contact
Your answer
Emergency Contact's Phone Number(s)
Your answer
Please provide a list of any individuals not listed above who may pick your child up from school
Your answer
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)
Your answer
You've reached the end of the form. Our registrar, Spring Younkin, 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
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