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AJCC ECE Preschool Summer Application
For students who will be 3 yrs old on 9/1/2020
Thank you for your interest in our AJCC ECE, we are looking forward to a great summer! Please Note: This application does not confirm acceptance, we will contact you by May 29th with an update on your enrollment status.
SEE TUITION RATES CHART
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Child’s Name
*
First
Last
Birthdate
*
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Parent/Guardian Names
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Phone #2
Email
*
Email #2
AJCC Membership is required to enroll in the ECE. Are you an AJCC Member?
*
YES
NO
Please select the schedule that you are interested in
*
3-Day (Mon, Wed, Fri)
5-Day (Monday-Friday)
What 3-day program works for you?
*
Preschool- 9:00am-1:00pm
Preschool Plus- 9:00am-2:30pm
What 5-day program works for you?
*
Preschool- 9:00am-1:00pm
Preschool Plus- 9:00am-2:30pm
Thank you for selecting our 3 Day 9 AM- 1 PM program. What months are you interested in?
*
JUNE (June 8th-July 3rd) $150 per week / $600 a month
JULY (July 6th-July 31st) $150 per week / $600 a month
AUGUST (August 3-August 28th) $150 per week / $600 a month
Thank you for selecting our 3 Day 9 AM- 2:30 PM program. What months are you interested in?
*
JUNE (June 8th-July 3rd) $200 per week / $800 a month
JULY (July 6th-July 31st) $200 per week / $800 a month
AUGUST (August 3-August 28th) $200 per week / $800 a month
Thank you for selecting our 5 Day 9 AM- 1 PM program. What months are you interested in?
*
JUNE (June 8th-July 3rd) $213 per week / $850 a month
JULY (July 6th-July 31st) $213 per week / $850 a month
AUGUST (August 3-August 28th) $213 per week / $850 a month
Thank you for selecting our 5 Day 9 AM- 2:30 PM program. What months are you interested in?
*
JUNE (June 8th-July 3rd) $285 per week / $1,140 a month
JULY (July 6th-July 31st) $285 per week / $1,140 a month
AUGUST (August 3-August 28th) $285 per week / $1,140 a month
Total
$ 0.00
Start dates other than the 1st day of the month will be prorated accordingly
Payment details
*
I would like to make my payment in Full (payment will be processed JUNE 5th)
I would like to make payments processed at the beginning of every month (JUNE/JULY/AUGUST)
Please note: the first payment will be processed on June 5th. The July and August payments will be processed on the 1st.
Please Note:
A non-refundable and non-transferable summer registration fee of $175 will be processed at the time of registration.
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.
I would like to contribute a one-time additional donation to help a child attend the ECE in the amount of....
By signing this form, I agree to the following conditions:
Registration fee is non-refundable and non-transferable.
*
Clear Signature
Please enroll my child as indicated by the above selections.
*
Clear Signature
Proof of immunization is necessary for my child to start the program and must be updated annually. Children's immunization records must be turned in within the first 30 days of your child beginning the Summer 2020 session.
*
Clear Signature
Upload immunization records below
Click or drag a file to this area to upload.
To be eligible for member rates, AJCC membership dues must be current throughout the time for which the child is registered.
*
Clear Signature
I understand I have 48 hrs days after confirmation of enrollment to withdraw without penalty. After this period, I understand I am responsible to pay the tuition for the remaining contract year or until my child’s spot is filled (with a minimum of a one (1) month penalty).
*
Clear Signature
There will be a $50 charge for NSF checks that are returned to the JCC.
*
Clear Signature
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.
*
Clear Signature
Tuition payment is required regardless of absence including, but not limited to, vacation, illness or unforeseen closure.
*
Clear Signature
I understand that I am responsible for tuition payments outlined in this contract and that I am responsible for providing the AJCC 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.
*
Clear Signature
I understand that late charges will be charged as incurred.
*
Clear Signature
Participation in AJCC activities constitutes permission for the agency to use any photos or videos of the participants for promotional purposes, without remuneration.
Clear Signature
Please do NOT use my child's photo for any promotional purposes.
Please do NOT use my child's photo for any promotional purposes.
Morning/Afternoon snack & lunches will be brought from home and follow healthy food and licensing guidelines. No food will be provided on site.
*
Clear Signature
Food Sensitivities/Allergies
I understand that the ECE does not allow outside food for celebrations, birthdays, etc unless they are pre-packaged, sealed with ingredient label, and are approved in advance and signed-off by the ECE Director.
*
Clear Signature
I understand that the ECE can change the food policy at any time based on need.
*
Clear Signature
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.
Clear Signature
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.
*
Clear Signature
Parent/Guardian Signature
Date
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Parent/Guardian Signature
Clear Signature
Parent/Guardian Signature
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