APPLICATION 2016-2017
CHILD’S NAME .............................................Date of birth .….......….................
Brookline
Hingham
Newton/Bernice B. Godine
Male
Female
Sharon/Gilson
Parent/Guardian Information
Parent/Guardian 2
Parent/Guardian Information
Parent/Guardian 1
This will be the mailing address of record for contract
and payment information.
Name.................................................................
Name.................................................................
Street address......................................................
Street address......................................................
City, state, zip .....................................................
City, state, zip .....................................................
Home phone number ...........................................
Home phone number ...........................................
Cell phone number ..............................................
Cell phone number ..............................................
Business name .....................................................
Business name .....................................................
Business phone number ........................................
Business phone number ........................................
Email address ......................................................
Email address ......................................................
MEMBERSHIP: All families enrolled in the ELC are members of the JCC from the first day of their child’s attendance. If parents/
guardians have different mailing addresses, we enter the name and address of Parent 1, and also the name of the second parent/
guardian (but not all members of the second household) for the purposes of membership. Please see your school director with questions.
PAYMENT:
If person responsible for payment is different from parent/guardian 1, please include the following information:
Name ...............................................................................................................................................
Address ..................................................................Phone.................................................................
Additional Child Information
Please note primary language of the child and/or parent(s), if other than English: .............................................
Siblings also attending JCC Early Learning Centers:
Name
Date of birth
1
2
3
It is helpful to us and our funders to know about the families we are serving. Please describe your family:
Jewish (including Jewish by birth, parentage, Interfaith relationship or self-definition)
Other
Prefer not to answer
If you were referred by current ELC family, please list name..........................................................................
Everyone welcome.
BOSTON
JCC
For office use:
Child IMIS #_____________
page 2
Program Site: Newton/Bernice B. Godine
Child’s name………………………………………...............… Date of birth .…..........…..
Male
Female
FULL YEAR 8am • 12 months September 6 – August 25 • Includes school vacation weeks and holidays
Infant (6 weeks-14months) (Full Year option only)
5 days .............. 8am-4pm .............. 8am-6pm
Toddlers (15 months-2.8 years)
2 days .............. T Th 8am-4pm ......
3 days .............. M W F 8am-4pm ..
5 days .............. 8am-4pm ..............
T Th 8am-6pm
M W F 8am-6pm
8am-6pm
Preschool (2.9-4 years)
5 days .............. 8am-4pm ..............
8am-6pm
Early Drop-Off
M ..........7:30am
T............7:30am
W..........7:30am
Th..........7:30am
F............7:30am
Pre-K (child will be eligible for Kindergarten by September 1, 2017)
5 days .............. 8am-4pm .............. 8am-6pm
Summer Option
Pending space availability, you may choose to come for the summer before the full year begins. Please see your ELC
director for more information and availability. If you choose this option, you will receive a separate summer contract.
Yes, I am interested in the summer option before the full year begins in September 2016.
SCHOOL YEAR 9am • 10 months September 6 – June 22 • Does not include school vacation weeks and holidays
Toddlers (15 months-2.8 years)
2 days ..............T Th 9am-1pm
3 days ..............M W F 9am-1pm
5 days ..............9am-1pm
Preschool (2.9-4 years)
5 days ..............9am-1pm
Early Drop-Off and Extended Day Options
M....
T .....
W ...
Th ...
F .....
7:30am....
7:30am....
7:30am....
7:30am....
7:30am....
until
until
until
until
until
4pm....
4pm....
4pm....
4pm....
4pm....
until
until
until
until
until
6pm
6pm
6pm
6pm
6pm
Pre-K (child will be eligible for Kindergarten by September 1, 2017)
5 days ..............9am-2pm
JCC CAMP OPTIONS FOR 4 YEAR OLDS
We invite you to explore JCC Camp options including JCC Kaleidoscope Arts & Science Camp in Newton or JCC
Grossman Camp in Dover. Bus transportation for Grossman is available from the Leventhal-Sidman JCC. Please see
your director for more information. Enrollment details will be available in January.
This application is the first part of the registration process. A non-refundable deposit of $400 (made payable to Jewish Community
Centers of Greater Boston) must be submitted with this application, $350 of which is applied to tuition and $50 to administrative
fees. Deposits are transferable only from one JCC Early Learning Center to another for the same child in the same year.
You will receive a contract with options for tuition payment in early spring 2016, and your first payment will be due by July 1.
Tuition includes a family membership at the Jewish Community Centers of Greater Boston. Thank you for choosing the JCC Early
Learning Centers.
Parent/guardian signature .....................................................................................Date......................................................
Print name ........................................................................................................................................................................