Playdates Form

Child’s Name *

Child’s Name #2

Child’s Name #3

Parent/Guardian Names *

Phone *

Phone #2

Email *

Email #2

Please select your child's schedule.

3 Day 9:00 am-2:30 pm
3 Day 9:00 am-1:00 pm
5 Day 9:00 am-2:30 pm
5 Day 9:00 am-1:00 pm

The ECE will offer winter play days December 21st - 31st, 9:00am-2:30pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $70 a day
Tuesday, December 22 / $70 a day
Wednesday, December 23 / $70 a day
Thursday, December 24 / $70 a day
Monday, December 28 / $70 a day
Tuesday, December 29 / $70 a day
Wednesday, December 30 / $70 a day
Thursday, December 31 / $70 a day

The ECE will offer winter play days December 21st - 31st, 9:00 am-1:00 pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $50 a day
Tuesday, December 22 / $50 a day
Wednesday, December 23 / $50 a day
Thursday, December 24 / $50 a day
Monday, December 28 / $50 a day
Tuesday, December 29 / $50 a day
Wednesday, December 30 / $50 a day
Thursday, December 31 / $50 a day

The ECE will offer winter play days December 21st - 31st, 9:00am-2:30pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $70 a day
Wednesday, December 23 / $70 a day
Monday, December 28 / $70 a day
Wednesday, December 30 / $70 a day

The ECE will offer winter play days December 21st - 31st, 9:00am-1:00pm (ECE is closed December 25th & January 1st). Please select the days you would like your child to attend. Play days will be billed in the month of service.

Monday, December 21 / $50 a day
Wednesday, December 23 / $50 a day
Monday, December 28 / $50 a day
Wednesday, December 30 / $50 a day

The ECE will offer spring play days April 5th-9th, 9:00am-2:30pm. Play days will be billed in the month of service.

The ECE will offer spring play days April 5th-9th, 9:00am-1:00 pm. Play days will be billed in the month of service.

The ECE will offer spring play days April 5th-9th, 9:00am-2:30pm. Play days will be billed in the month of service.

Monday, April 5 / $70 day
Wednesday, April 7 / $70 a day
Friday, April 9 / $70 a day

The ECE will offer spring play days April 5th-9th, 9:00am-1:00pm. Play days will be billed in the month of service.

Monday, April 5 / $50 day
Wednesday, April 7 / $50 a day
Friday, April 9 / $50 a day

Total (There will be a total of 10 payments processed on the 17th of each month starting with August 17th)

$ 0.00

How would you like to pay? *

Credit Card
EFT (attach voided check)
Payroll deduction (AJCC STAFF ONLY)

If you have a change of payment information please contact Rachel Gordon at rgordon@alpertjcc.org

Name on Credit Card: *

Last 4 digits for card on file *

Exp. *

Upload image of a voided check below *

Click or drag a file to this area to upload.

By signing this form, I agree to the following conditions:

Please enroll my child as indicated by the above selections. *

I understand I have up to a month prior to the start of Winter and Spring Play Days, November 21, 2020 and March 5, 2021, respectively to withdraw my Play Days enrollment without penalty. After these dates I am responsible for full payment. *

There will be a $50 charge for failed or returned payments *

We reserve the right to withhold services. The applicant agrees to abide by all rules and regulations of the Alpert JCC and I understand that failure to act in accordance with the rules may result in expulsion from the Alpert ECE with no refund. *

Tuition payment is required regardless of absence including, but not limited to, vacation, illness or unforeseen closure. *

I understand that I am responsible for tuition payments outlined in this contract and that I am responsible for providing the Alpert JCC with updated payment information if necessary. I understand that if any past due payments are not paid within 48 hours of notification services will be suspended or terminated. *

I understand that late charges will be charged as incurred at $1 a minute for every minute late. Charges will be processed automatically with the card on file the next business day. *

Morning/Afternoon snack & lunches will be brought from home and follow healthy food and licensing guidelines. No food will be provided on site. *

I understand that the ECE can change the food policy at any time based on need. *

Coronavirus / COVID-19 Warning & Disclaimer: Coronavirus a/k/a COVID-19 is an extremely contagious virus that spreads easily through person-to-person or other contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in programs or activities upon the AJCC ECE premises could increase the risk of contracting COVID-19. The AJCC ECE in no way warrants that COVID-19 infection will not occur through participation in programs or activities upon the AJCC ECE premises. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in my and my child’s entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and my child’s participation in any of the AJCC ECE’s programs and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain as a result of my entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and/or my participation in any of the AJCC ECE’s programs and that by signing this agreement I HEREBY RELEASE THE AJCC ECE from all liability for such loss, damage, or death. I further certify that my child is in in good health and has no conditions or impairments which would preclude their safe entry upon the AJCC ECE premises, the use of any of the AJCC ECE’s facilities or equipment, and/or their participation in any of the AJCC ECE’s programs. *

By signing below I understand and agree that I am financially responsible for payment. I understand that delinquent payments not paid within 48 hours of notification will result in suspension or termination of services. *

Parent/Guardian Signature

Date *//

Parent/Guardian Signature

Date//

Please fill out the form below to confirm your child’s playdates for the year

By signing this form, I agree to the following conditions:

OUR MISSION

WHAT'S OPEN AND WHAT'S CLOSED

CONTACT US