Participant Information
* GenderPlease Select One Male Female
* T-Shirt SizePlease Select One Youth Small Youth Medium Youth Large Small Medium Large X-Large
Medical Information
* AllergiesPlease indicate any allergies your child may have.
* MedicationsPlease indicate any and all medications your child is taking.
* Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)
Additional Information Please share any information that would help us better educate your child.
JEC Medication Policy
Please be aware the JEC Staff IS NOT allowed to administer medication without written consent from a guardian. This also includes over-the-counter medications (ex. Ibuprofen and Tylenol). If medication is required, please bring medications in their ORIGINAL bottles packed in a resealable plastic bag labeled with the child's name and dosage instructions.
Add Additional Participant: Please Select One Add another student
Participant 2 Information
Gender Please Select One Male Female
* T-Shirt SizePlease Select One Youth Small Youth Medium Youth Large Small Medium Large X-Large
Student 2 Medical Information
Allergies Please indicate any allergies your child may have.
Medications Please indicate any and all medications your child is taking.
Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)
Additional Information Please share any information that would help us better educate your child.
JEC Medication Policy
Please be aware the JEC Staff IS NOT allowed to administer medication without written consent from a guardian. This also includes over-the-counter medications (ex. Ibuprofen and Tylenol). If medication is required, please bring medications in their ORIGINAL bottles packed in a resealable plastic bag labeled with the child's name and dosage instructions.
Add Additional Participant: Please Select One Add another student
Participant 3 Information
* GenderPlease Select One Male Female
* T-Shirt SizePlease Select One Youth Small Youth Medium Youth Large Small Medium Large X-Large
Student 3 Medical Information
Allergies Please indicate any allergies your child may have.
Medications Please indicate any and all medications your child is taking.
Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)
Additional Information Please share any information that would help us better educate your child.
JEC Medication Policy
Please be aware the JEC Staff IS NOT allowed to administer medication without written consent from a guardian. This also includes over-the-counter medications (ex. Ibuprofen and Tylenol). If medication is required, please bring medications in their ORIGINAL bottles packed in a resealable plastic bag labeled with the child's name and dosage instructions.
Add Additional Participant: Please Select One Add another student
Participant 4 Information
* GenderPlease Select One Male Female
* T-Shirt SizePlease Select One Youth Small Youth Medium Youth Large Small Medium Large X-Large
Student 4 Medical Information
Allergies Please indicate any allergies your child may have.
Medications Please indicate any and all medications your child is taking.
JEC Medication Policy
Please be aware the JEC Staff IS NOT allowed to administer medication without written consent from a guardian. This also includes over-the-counter medications (ex. Ibuprofen and Tylenol). If medication is required, please bring medications in their ORIGINAL bottles packed in a resealable plastic bag labeled with the child's name and dosage instructions.
Parent 1--Primary Contact Information
* Best way to get in touch?Please Select One Cell Phone Work Phone Email
Parent 2--Secondary Contact Information
Best way to get in touch? Please Select One Cell Phone Work Phone Email
Emergency Contacts-- Other than Primary/Secondary
Emergency Contact 1
Emergency Contact 2
Additional individuals to pick up your child: Please Select One Add additional pick up people
Photo Consent
Billing
Tuition Rates:
Member
Nonmember
1st child
$800
$1200
2nd child and more
$750
$1150
Tuition for Kadima is only based on membership. There is no multiple child discount for Kadima.
Member: $275
Nonmember: $325
* Preferred payment method:Please Select One Cash Check Credit Card
Credit Card Information
Type: Please Select One Visa Master American Express