2019-2020 JCCNS School Year Registration
Fill out this form to register your child(ren) for the JCCNS school year.
Email address *
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 Information
Emergency Contact *
Your answer
Emergency Contact's Phone Number(s) *
Your answer
Authorized Pick-up
Please list names of individuals who are allowed to pick up your child from school other than parents (such as grandparents, babysitters, etc.)
Your answer
Student Registration Information
Registration Type *
Please Check the box(es) of the Morning Sessions (8:30am-12pm) for which you would like to enroll your child. **WEDNESDAY MORNINGS FULL** (any questions please contact registrar@jccnursery.org)
Please Check the box(es) of the Afternoon Sessions (12pm-2pm) for which you would like to enroll your child.
Would you be interested in enrolling for additional afternoons if they were offered? Which ones?
Your answer
How did you hear about the JCCNS? *
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 (follow the link above). *
Your answer
You've reached the end of the form. We 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 March 1, 2019, and $60 March 1, 2019 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. is a 501(c)(3) and 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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service