JEMS Application

JEMS ACADEMY APPLICATION

1117 North Miami Beach Blvd - North Miami Beach, FL 33162 -- ‪(786) 505-1617‬
Child's Name*

First NameMiddle NameLast Name
Student Image
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.

Child Prefers to be Called*
Hebrew Date of Birth*
(ex: 24 Shvat: go to hebcal.com to lookup if you are unsure)
Date of Birth*

MonthDayYear
Date
Current Shul Affiliation*
Rav
Rabbi's Contact Number
Please enter a valid phone number.
Parent's Marital Status

MarriedDivorcedSeparated
Child LIves With*

FatherMotherBrother(s)Sister(s)

Please List Siblings (if applicable) and what schools they are currently in.

	Name	Age	Current School	Grade
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Sibling 5
Sibling 6
Sibling 7
Sibling 8

Please list Sibling(s), if applicable

What school is your child currently enrolled in?
Contact Name at Current School
Contact Number at current school
Please enter a valid phone number.
Previous Schools and Contact Information
Does your child currently receive the Gardiner / McKay scholarship?

YesNo

Father's Name*

PrefixFirst NameLast Name
Father's Cell Phone
Please enter a valid phone number.
Father's Work Phone Number
Please enter a valid phone number.
Father's Email Address
example@example.com
Father's Home Address (if different from student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mother's Name*

PrefixFirst NameLast Name
Mother's Cell Phone Number*
Please enter a valid phone number.
Mother's Work Number
Please enter a valid phone number.
Mother's Email Address
example@example.com
Mother's Home Address (if different from student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where did you hear about JEMS? Did someone refer you? We would like to thank them.*

Pediatrician Name*

First NameLast Name
Pediatrician Number*
Please enter a valid phone number.
What insurance does your child have*

As part of our application process, we encourage your child to join our classroom for a 2-day trial to see that it is a good fit for them.

JEMS Application FeeThe application will proceed upon receipt of the application fee, which will be applied to your registration fee upon acceptance. Please note that application fees are nonrefundable and include two days of student trial.

$200.00

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

JEMS Academy Trial Waiver
Please sign and date the waiver below

I hereby waive any claims against JEMS Academy, its agents, employees, representatives, and assigns for any and all injuries, damages, or losses that may occur to my child, while participating in any school activities. This waiver releases JEMS Academy from all liability relating to injuries that may occur on location before, during, or after trail.

I understand and acknowledge that participation in school activities involves inherent risks and dangers. I assume all such risks for my child and release the school from any and all liability arising out of my child’s participation in such activities.

I further acknowledge that I have read and fully understand this waiver and its contents, and that I voluntarily and knowingly waive any legal rights that I, my child, or any other party may have against the school as a result of my child’s participation in the trial.

This waiver shall remain in effect for the entire time my child attends JEMS Academy.
Signature

Clear
By Typing your name below you agree to the statements above:*
Upon completion of this form, you will be contacted by a JEMS representative regarding the acceptance of this application

Please contact us at contact@jemsacademy.org or ‪(786) 505-1617‬ with any additional questions.
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JEMS ACADEMY APPLICATION

As part of our application process, we encourage your child to join our classroom for a 2-day trial to see that it is a good fit for them.

Payment Methods