Application for 2019-20 School Year
You must complete a separate form for each child that you are registering for Kids Center.
Before & After School Care for K4-6th Grade
Before School Care 7:00 – 9:00 AM
After School Care 3:00 – 6:00 PM (5:30 PM Fridays)

• Transportation provided to and from local elementary and middle schools. Find a full list of current schools at jccmilwaukee.org/programs/education-families/before-after-school

• After School Classes - Kids have the whole JCC at their disposal and take everything from swim lessons to sports, art, and STEM classes because enrollment in Kids Center includes vouchers for classes based on the number of days each child attends.

• Dedicated, supervised homework room keeps kids on track for school success and allows your family to enjoy a more peaceful evening at home.

• Plenty of opportunities to just be a kid and play with friends in a smaller age-group setting.

• Adjacent courtyard provides lots of space to explore outside year-round.

• Inclusive and engaging Shabbat and holiday experiences are created just for Kids Center

• Kids Center Vacation Days & JCC Day Camps offer busy families added coverage throughout the year


Complete this form to enroll or contact Ronna Ruffin at rruffin@jccmilwaukee.org to learn more.

About your child
Child's name *
Your answer
Child's Birth date *
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Child's grade for Fall 2019 *
School child attends *
Your answer
I would like you to know the following about my child: *
Your answer
This may include behavior strategies used at home, family or school considerations, or anything that may help us make your child’s Kids Center experience better.
Registration for 2019-20
Prices listed are per month for 9 months.
Kids Center families receive special vouchers to be used for after school classes or Vacation Days – one $50 voucher for each day of the week that your child is registered. Ex: 5 days a week = five $50 vouchers per year).

BEFORE SCHOOL CHILDCARE (includes bus transportation)
5 Days per week • JCC Members $205 • Community $225
4 Days per week • JCC Members $175 • Community $205
3 Days per week• JCC Members $145 • Community $175
2 Days per week • JCC Members $115 • Community $145

AFTER SCHOOL CHILDCARE with bus transportation
5 Days per week • JCC Members $385 • Community $425
4 Days per week • JCC Members $355 • Community $395
3 Days per week• JCC Members $305 • Community $345
2 Days per week • JCC Members $245 • Community $285

AFTER SCHOOL CHILDCARE
For on-campus partners without bus transportation
5 Days per week • JCC Members $265 • Community $295
4 Days per week • JCC Members $235 • Community $285
3 Days per week• JCC Members $205 • Community $245
2 Days per week • JCC Members $185 • Community $205

AFTER SCHOOL TRANSPORTATION TO JCC ONLY (No care)
For JCC Members Only • 9 years and older
5 Days per week $155
4 Days per week $125
3 Days per week $95
2 Days per week $65
1 Day per week $45

HEBREW SCHOOL TRANSPORTATION
JCC Members $310/year • Community $360/year

Kids Center Gold (JCC Members Only)
5 Days per week + all Vacation Days, Winter & Spring breaks

COMBO - BEFORE & AFTER SCHOOL CARE
With bus transportation $625
For on-campus partners without bus transportation $475

AFTER SCHOOL CARE ONLY
With bus transportation $505
For on-campus partners without bus transportation $385

Your Child's 2019-20 Registration
Register this child for:
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Kids Center Gold Combo (JCC Mermbers)
Kids Center Gold After School Only (JCC Mermbers)
Before School Care
After School Care with transportation
After School Care without transportation
After School Transportation Only (JCC members ages 9+)
Hebrew School Transportation
Name of synagogue if registering for Hebrew School transportation
Your answer
Allergies/Medical Information
Does your child have any allergies? *
Please describe any allergies:
Your answer
Does your child have any medical conditions that we need to understand? *
Please provide any medical information that we will need to care for your child:
Your answer
Does your child have an IEP? *
Please describe the purpose of your child's IEP:
Your answer
Does your child take any medication on a regular basis? *
Please list name, dosage, and purpose of any medications:
Your answer
A medication authorization form will need to be completed for any medications that will be given while in Kids Center.
Does your child have any physical limitations? *
Please describe:
Your answer
Name of your child's healthcare provider *
Your answer
Preferred hospital *
Your answer
Complete Your Registration
Parent/Guardian #1 Name *
Your answer
Parent/Guardian #1 Email *
Your answer
Parent/Guardian #1 Mobile phone *
Your answer
Parent/Guardian #1 Work phone
Your answer
Parent/Guardian #1 Place of business
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 Email
Your answer
Parent/Guardian #2 Mobile phone
Your answer
Parent/Guardian #2 Work phone
Your answer
Parent/Guardian Place of business
Your answer
Child's main address *
Your answer
Child lives with: *
Emergency Contact #1 (Name, phone number, relationship to child) *
Your answer
Emergency Contact #2 (Name, phone number, relationship to child)
Your answer
If your family is new to JCC Kids Center, and you were referred by one of our current families, please enter their name here.
Your answer
Payment Options
Families will receive 10% discount for second child in Kids Center or Gan Ami.

$100 deposit due and payment plan must be established at time of registration.

Payment of $100 deposit *
Payment Plan for Kids Center 2019-20 School Year *
Authorizations
Today's date *
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Permission to Treat & Transport
1. I give permission to the Harry & Rose Samson Family JCC to take any emergency (e.g. first aid, disaster evacuation) measures deemed necessary by the JCC staff for the care and protection of my child while under the supervision of the JCC.

2. In case of a medical emergency, I understand that my child will be transported at my expense to the nearest hospital by the local emergency resource (EMT/First Response) deems it necessary.

3. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child’s physician and/or other adult acting on the parent’s behalf.

4. I give permission to allow the Harry & Rose Samson Family JCC to provide transportation for my child between school and program locations.

Please type your name to grant permission treat and transport as described above. *
Your answer
Kids Center Payments & Fee
• This agreement signifies a financial commitment for the school year 2019-2020. Any cancellations require a one
month notification. Tuition will be prorated for any additional portion of time.

• The Kids Center school calendar is set with a minimum of 180 days, in accordance with local public schools. Fees
are set accordingly. There are no fee adjustments for holidays, illness or school closings.

• Changes in schedule are contingent on space availability. Changes in a child’s selected days, times or schedules will
be free of charge when communicated no later than September 1, 2019. After that time, each family will receive
one opportunity to change their schedule free of charge. Any additional change of schedule will result in a $25
charge per child, per change.

• We understand that “life happens” (example: out of town travel, doctor’s appointments or meetings.) We will
make every effort to accommodate requests for one-day additions to your child’s Kids Center schedule. Requests
must be made and confirmed with the Director of Youth Programs. There will be a charge of $20 (no
transportation) and $25 (full transportation) per child, per day. This arrangement is subject to availability.

• If your child will be absent from Kids Center, you must call the transportation hotline, 414-967-8267, to report the absence. Due to the size of our program, it is imperative that absences are called in to the hotline. There will be a $15 fee charged to your account for each forgotten call after a second no-call.

• The JCC reserves the right to withdraw your child with thirty (30) days written notice if a payment plan is not
maintained.

• If you are interested in applying for financial assistance for your child, please email scholarship@jccmilwaukee.org.
Financial assistance is not automatically renewed. Families need to apply each program year. If a family’s financial
situation changes, a new application needs to be completed.

• When you register, you will be charged a non-refundable $100 deposit, which will be applied toward the May
payment.

• If your child will be absent from Kids Center, you must call the transportation hotline, 414-967-8267, to report the absence. Due to the size of our program, it is imperative that absences are called in to the hotline. There will be a $15 fee charged to your account for each forgotten call after a second no-call.

Please type your name to verify that you understand the payment policies described above. *
Your answer
Kids Center Policies & Procedures
• The program hours of operation are 3:00 PM-6:00 PM (Friday close at 5:30 PM.) Children must be picked up
promptly. Please refer to the school calendar for all holidays (religious and secular) and early closing days. Families
who pick up their child beyond the scheduled pick up time will be assessed a fee at the rate of $1.00 per minute.

• All required forms must be submitted prior to your child’s first day of attendance (within 30 days for health and
immunization).

• Children enrolled in an after school class will be walked to and picked up by JCC staff. To ensure an efficient
experience, parents’ should inform the Director of Youth Programs when a child is enrolled in a JCC enrichment
program or class. Kids Center kids should not take 4PM swim lessons.

• For families who select our two or three-day programs or transportation only, we do our best to accommodate
your choice of days. However, you may only be able to enroll if space is available. If space is not available, you will
be informed which days are available before confirming your registration.

• I understand that the JCC may use photos, media, or commentary from its programs for publicity, promotion, or
other engagement opportunities.

Please type your name to verify that you understand the policies and procedures described above. *
Your answer
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