Jewish Learning Center Registration Form 2018-2019 Academic School Year
Please use this form to register for JLC classes for your student for next year. You can use one form for all of your children.
Email address *
Mother First and Last Name *
Your answer
Father First and Last Name *
Your answer
Address with City State and Zip Code *
Your answer
Mother Email *
Your answer
Father E-mail
Your answer
Mother Cell Phone number *
Your answer
Father Cell Phone Number *
Your answer
Emergency Contact Information (Other than Parent) Name and Cell Phone Number Please. *
Your answer
Child 1 First and Last Name *
Your answer
Child 1 Birthday *
MM
/
DD
/
YYYY
Child 1 Grade Level in 2018-2019 School year *
Child 1 Allergies
Your answer
Child 2 First and Last Name
Your answer
Child 2 Birthday
MM
/
DD
/
YYYY
Child 2 Grade Level 2018-2019
Child 2 Allergies
Your answer
Child 3 First and Last Name
Your answer
Child 3 Birthday
MM
/
DD
/
YYYY
Child 3 Grade Level 2018-2019 Academic School Year
Child 3 Allergies
Your answer
I/We Understand I/we will be financially responsible for a Materials Fee of $118 per child, A Parent Council Fee of $36 per family, and a Participation Bank Payment of $180 per family. *
Membership Acknowledgement *
Additional Comments to Principal
Your answer
A copy of your responses will be emailed to the address you provided.
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