JCK After School Programs @ Eitz Chaim Spring Farm - Winter/Spring Session Feb.8th - May 31st 2018
Please fill out a separate form for each child
Child's Last Name
Child's First Name
Guardian's First Name
Mother's cell #
My child is currently in grade
I am registering my child in the NeshamaDance Winter/Spring programs:
Thursdays (13 classes - Begins Feb.8th:) NeshamaDANCE Mix Jazz+ Zumba (Gr.2-5) 4:00-5:00 Instructor: Keri Roth $210.00 (Includes JCK performance top)
Payment Options: 1. E-transfers to
2. Cheque: Payable to JCreative Group Inc.
Drop off cheques at the Eitz Chaim Spring Farm Office for Keri Roth (NOT ECMA please or it will get put with the Pizza orders!) Payment Programs are available. Email
Are there any medical/ emergencies/ allergies that we should be aware of?
Emergency contact #1 Name & Number
Emergency contact #2 Name & Number
JCreative Group posts pictures of our after school activities on our website and social media. Photos may also be used for marketing purposes. If you do not wish to have your child appear in any photos please email us at
I hereby provide my child with permission to participate in all programs provided by JCK (Jewish Creative Kidz) and JCreative Group Inc at Eitz Chaim Spring Farm. I hereby remove JCreative Group Inc. from being responsible for any injuries that may occur in any activities while my child is enrolled in the program.
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