LJCC Religious School Enrollment Form
Contact Rachel Downs-Doubrava at rachelmddljcc@gmail.com with questions/concerns.

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LJCC Religious School Enrollment Form:

Please fill out the following LJCC registration/enrollment form for students planning to attend Religious School for the 2025-2026 school year.
Student 1 Name
Please mark accordingly for this student:
Date of Birth
MM
/
DD
/
YYYY
Grade Level
Student 2 Name
Please mark accordingly for this student:
Column 1
Preschool
Primary (K-7)
Teen Programming
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Grade Level
Student 3 Name
Please mark accordingly for this student:
Column 1
Preschool
Primary (K-7)
Teen Programming
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Grade Level
Guardian 1 Name
Emergency Contact?
Clear selection
Guardian 1 physical address
Guardian 1 phone number
Guardian 1 email address
Guardian 2 Name
Guardian 2 Emergency Contact?
Clear selection
Guardian 2 physical address
Guardian 2 phone number
Guardian 2 email address
LJCC Membership Status
Clear selection
Please contact Lara Giordano for membership details.
@lgiordanoljcc@gmail.com

I give the LJCC permission to use photos of my children within the following media:

Upon signing this form it is understood that:


Guardians will make their best efforts to bring their students to attend on a regular basis and in a timely fashion.

Students will be accompanied by a guardian if any of the following are true:

   Child is not potty trained.

   Child is prone to disruptive patterns that include emotional or behavioral episodes, violence, or bullying.

Signature Guardian 1
Date:
MM
/
DD
/
YYYY
Signature Guardian 2
Date:
MM
/
DD
/
YYYY
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