Name: Parents as Partners - Fall 2023 Registration
SKU: 2799
Price: 400.00 USD
Availability: InStock

North Williamsburg

Parents as Partners – Fall 2023 Registration

5 Classes for $350 with a registration fee of $50:
9/29/2023
10/06/2023
10/13/2023
10/20/2023
10/27/2023

Parents as Partners Registration

Product Name

Name(Required)

First Last

Date Of Birth:(Required)

Gender:(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1 Name:(Required)

First Name: Last Name:

Email(Required)

Occupation(Required)

Cell Phone Number:(Required)

Parent/Guardian 2 Name:

First Name Last Name

Cell Phone Number:

Is there any siblings?(Required)

How many siblings?(Required)

Please enter a number from 0 to 6.

Sibling Name 1:

First Name Last Name

Gender

Date of Birth:

Grade

School

Sibling Name 2:

First Name Last Name

Gender

Date

Grade

School

Emergency Contact 1(Required)

First Name Last Name

Cell Phone Number:(Required)

Relationship(Required)

Emergency Contact 2(Required)

First Name Last Name

Cell Phone Number:(Required)

Relationship(Required)

Applicant Status(Required)

How did you learn about JCC Brooklyn - North Williamsburg?

Has your child previously enrolled or is currently enrolled in classes? If NO, leave blank. If YES, when and where?

Class Schedule

5 Classes for $350 with registration fee of $50:
10/06/2023
10/13/2023
10/20/2023
10/27/2023
11/03/2023

Tell us about your family. Please add any allergies or medical conditions that we should know about:

Please let us know about any dietary restrictions:

Primary language(s) spoken at home?

Does your child speak more than one language at home. If so, what language(s)?

Is there any other information you feel we should know that would help us more fully understand your child or family?

Terms of Enrollment: The JCC Brooklyn - North Williamsburg/a project of the Kings Bay Y will not be responsible for damage to, or loss of, personal property. It is the goal of our program to provide a healthy and safe environment for all participants. If a participant displays any inappropriate behavior, or endangers the health and safety of participants or staff, we may suspend the participant from the program or consider permanent termination in extreme situations.

A service charge of $125 will be applied for any refunds or cancellations.

Release: I hereby give my permission for my child to participate in all programs, activities and trips. I understand and fully recognize that risks are involved and I hereby release the JCC Brooklyn - North Williamsburg/a project of the Kings Bay Y or any of its sponsors, benefactors, or employees from any liability arising out of any injury to my child in the event of a medical emergency or surgical emergency. I do hereby give authority to the program and staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. I grant permission to the physician designated by the JCC Brooklyn - North Williamsburg/a project of the Kings Bay Y to hospitalize, secure proper treatment for, and order injections, anesthesia or surgery for my child. Furthermore, I understand that payment for medical services is solely the family’s responsibility. I hereby give permission to the JCC Brooklyn/Kings Bay YM-YWHA, Inc. to take photographs of me and/or my child to be shown in a video, brochure, advertisement, or internet display for purposes of promoting interest in the JCC Brooklyn/a project of the Kings Bay Y. I release the JCC Brooklyn/ Kings Bay YM-YWHA, Inc. from any claims resulting from the pictures taken on, before, or after the date of this communication. I do hereby give permission for my child to participate in all activities, including off-ground activities. I authorize the JCC Brooklyn/Kings Bay YM-YWHA, Inc. to act as a parent surrogate on my behalf. I realize that itineraries and/or programs are subject to change prior to, and during, the year.

I have read the terms of enrollment and agree to abide by them. Our $50 Non-refundable Registration Fee, payable to JCC Brooklyn, is enclosed.

Parent/Guardian 1 Signature:(Required)

Date(Required)

Parent/Guardian 2 Signature:

Date

Subtotal
Options
Total

Quantity

Category: Uncategorized

Description
Additional information

5 Classes for $350 with a registration fee of $50:
9/29/2023
10/06/2023
10/13/2023
10/20/2023
10/27/2023

Additional information

Classes	Summer Classes- June 30th – July 28th, Spring Classes- March 17th to May 26th

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North Williamsburg