Program Registration Form

Program Registration Form

11685 Yonge St. (North Richmond Hill Campus)
Student(s) Information
First Child*

First NameLast Name
Second Child

First NameLast Name
First Child's Birthday*

MonthDayYear
Date
Second Child's Birthday

MonthDayYear
Date
First Child's Current School*
Second Child's Current School (If it is the same as the first child's leave blank)
Grade in Sept 2026(First Child)*
Grade in Sept 2026 (Second Child)
Allergies*
Special Medical, Physical or Emotional Needs that our teachers should be made aware of.
Parent Information
Parent Name*

PrefixFirst NameLast Name
Cell Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Email*
example@example.com
Home Address*

Street Address

CityState / Province

Postal / Zip Code
Consent*

I agree to receive e-mails from JEI Learning Center containing information regarding JEI Learning Center’s promotions. I can withdraw my consent at any time. (Please refer to our Privacy Policy or contact us for more details.)
Emergency Contact Information (Other than parent) - if applicable
Emergency Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child
Authorized for pickup

YesNo
Program(s) of interest- please choose the specific program for which you wish to receive information.
JEI Subject Programs

JEI EnglishJEI Reading & WritingJEI MathSubject Evaluation
Please choose from our available JEI Subject Programs Class Days/Times

Wednesday 4:00-5:00 (1 spot available)Wednesday 5:00-6:00 (2 spots available)
After School Club Program (JK-Grade 6)

5 Day Program4 Day Program3 Day ProgramShuttle School Pick-up required
PA Day Camp 9am-3pm | Extended hours 3-5pm, $15/day

Friday, Jun 5, 2026 (Flower Power)Friday, Jun 26, 2026 (Seaside Escape)Daily Rate $95.00 (9am-3pm includes pizza)
Summer Learning Club Drop-in Program July-August
Choose your subject(s) and your Pass option
Summer Camp (JK-Grade 4) 9am-3pm at Elgin Mills / North Richmond Hill Campuses

Week 1: July 6-10Week 2: July 13-17Week 3: July 20-24Week 4: August 10-14Week 5: August 17-21Week 6: August 24-28All 6 weeks $430/week + FREE LUNCHSign up 3 to 5 weeks $430/week + FREE LUNCHEarly Bird $450/week + FREE LUNCHAdd-on 8am drop-off $40/weekAdd-on 3-4pm PROMO $75/week (One JEI Program)Add-on 3-5pm PROMO $145/week (Two JEI Programs)Standard Lunch Plan $85/week (4 days)
Comments/Questions
Terms & Conditions
Please click yes if you WILL give permission to have photographs taken of your child.*

YesNo
We occasionally take pictures of the children in action with the materials or doing other activities for our website and various Social Media platforms. We hope to use these to keep parents up to date on the happenings at the center.
How did you find us?*
If you were referred by a friend, please let us know so we can thank them!
Parent Signature*
Enter the message as it's shown*
IMPORTANT: This form simply accepts your registration information. It is not a confirmation of guaranteed enrollment, as spaces in our class and camp programs are limited. We will contact you within two business days to communicate if your desired session is available. If it is, we will formally confirm your registration and send you the program information packet and payment link. Thank you for your attention.
Should be Empty:

Program Registration Form

Student(s) Information

Parent Information

Emergency Contact Information (Other than parent) - if applicable

Program(s) of interest- please choose the specific program for which you wish to receive information.

Terms & Conditions